NATIONAL EDUCATION TESTING AND RESEARCH CENTER

NATIONAL ACHIEVEMENT TEST FOR GRADE SIX IMPORTANT

EXAMINEE STUB DO NOT LOSE TH!S STUB
EXAMINEE NO.

0357330
(LAST NAME FIRST NAME
Ml J

- GRADE SIX
EXAMINEE NO.
LAST NAME FIRST NAME Mi
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MARKING INSTRUCTIONS
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• Erase cleanly any marks
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on this form.

---
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REG DIV SCHOOL ID SCHOOL SUBJECT GRADE
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00 00 ® ®®®®®® 00 0 0 0 0 0 Enrolled in MADRASAH-

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Q JUN 10 0 ® ®®®®®® ®® -
Q JUL © ©© 11 ® ® ® ® ® ® @Yes@No
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Q SEP NCR @ LEARNER REFERENCE NUMBER (LRN) -
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FORTHOSE IN PRIVATE SCHOOLS:
Q OCT CAR ®
Q NOV ® ®® ARMM ® Are you a GASTPE grantee? 0®
Q DEC ® ®® CA!'AGA @
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GENDER
NUTRITIONAi:STAtuS
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0Above Normal @ Male
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0Normal ® Female NUMBER OF SHIFTS PER DAY {GS) ©©©©©©©©©000 -
0Below Normal -
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ELEMENTARYSCHOOLTYPE
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Q Central / Pilot ES 0 Multi-grade School 0 Private Non-Sectarian -
0 0 0 000000000000
Non-Central ES State College/University ES Madaris School -
0 Primary School 0 Private Sectarian ®®®®®®®®®®®® -
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ANSWER FOR EXAMINEE'S
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I HEREBY RECOGNIZE THE AUTHORITY OF THE SECRETARY
OF EDUCATION TO EVALUATE MY ANSWER SHEET IN
ACCORDANCE WITH ITS IMPLEMENTING RULES, REGULATIONS
AND PUBLIC POLICY. EXAMINEE'S SIGNATURE OVER PRINTED NAME
NAME OF SCHOOL

ADDRESS OF SCHOOL