%PDF-1.5 % 145 0 obj <> endobj xref 145 114 0000000016 00000 n 0000002673 00000 n 0000003542 00000 n 0000003608 00000 n 0000003896 00000 n 0000004108 00000 n 0000004220 00000 n 0000004284 00000 n 0000004374 00000 n 0000004452 00000 n 0000004626 00000 n 0000004792 00000 n 0000004824 00000 n 0000004982 00000 n 0000005149 00000 n 0000005181 00000 n 0000005339 00000 n 0000005508 00000 n 0000005540 00000 n 0000005698 00000 n 0000005867 00000 n 0000005899 00000 n 0000006057 00000 n 0000006208 00000 n 0000006240 00000 n 0000006392 00000 n 0000006534 00000 n 0000006566 00000 n 0000006718 00000 n 0000006853 00000 n 0000006885 00000 n 0000007037 00000 n 0000007227 00000 n 0000007259 00000 n 0000007418 00000 n 0000007594 00000 n 0000007626 00000 n 0000007778 00000 n 0000007921 00000 n 0000007953 00000 n 0000008105 00000 n 0000008289 00000 n 0000008447 00000 n 0000008610 00000 n 0000008763 00000 n 0000008795 00000 n 0000008947 00000 n 0000009117 00000 n 0000009149 00000 n 0000009308 00000 n 0000009464 00000 n 0000009496 00000 n 0000009655 00000 n 0000009819 00000 n 0000009851 00000 n 0000010003 00000 n 0000010193 00000 n 0000010225 00000 n 0000010384 00000 n 0000010408 00000 n 0000010437 00000 n 0000010467 00000 n 0000010497 00000 n 0000010527 00000 n 0000010557 00000 n 0000010587 00000 n 0000010610 00000 n 0000010668 00000 n 0000010723 00000 n 0000010753 00000 n 0000010786 00000 n 0000010816 00000 n 0000010844 00000 n 0000010874 00000 n 0000010920 00000 n 0000010952 00000 n 0000010985 00000 n 0000011051 00000 n 0000011119 00000 n 0000011190 00000 n 0000011450 00000 n 0000011713 00000 n 0000011976 00000 n 0000012239 00000 n 0000012482 00000 n 0000012810 00000 n 0000013060 00000 n 0000013392 00000 n 0000013635 00000 n 0000013962 00000 n 0000014212 00000 n 0000014543 00000 n 0000014786 00000 n 0000015114 00000 n 0000015364 00000 n 0000015697 00000 n 0000015765 00000 n 0000015836 00000 n 0000016079 00000 n 0000016407 00000 n 0000016657 00000 n 0000016989 00000 n 0000018128 00000 n 0000025640 00000 n 0000026816 00000 n 0000026976 00000 n 0000027622 00000 n 0000027802 00000 n 0000027977 00000 n 0000028217 00000 n 0000028512 00000 n 0000028747 00000 n 0000003193 00000 n 0000002846 00000 n trailer<<013cfdceec9f9e471cd7d66d83cc0ea7>] >> startxref 0 %%EOF 146 0 obj <>/Metadata 10 0 R/AcroForm 147 0 R/Outlines 6 0 R/ViewerPreferences<< >>>> endobj 258 0 obj<
>stream xc```b`N``g`π @1vkk{nq0H> `f`s8Iys/}g90 L Z@R;OLJ@ if+Io:<0,&sWnr[x=d_ͽ{+oz,0l˻כwH`5P"EyyyNyy<{#(j iF bV`OU1 Ĝ`Q w endstream endobj 257 0 obj <>stream xB E.[=l0[sEKX VQְ lb.n&8)p\ x1<'$-x9<".^x^xo-w. #|O)>_+|o-?'_+~/<?R E)2*H4HHtHlM#}2 C2"c2!S2#s K"5 endstream endobj 147 0 obj <> endobj 148 0 obj <>>>/MediaBox[0 0 612 792]/Contents 247 0 R/Group<>/Tabs/S/StructParents 0/Annots 149 0 R/CropBox[ 0 0 612 792]/Rotate 0>> endobj 149 0 obj [ 154 0 R 155 0 R 158 0 R 161 0 R 164 0 R 167 0 R 170 0 R 173 0 R 176 0 R 179 0 R 182 0 R 185 0 R 186 0 R 187 0 R 188 0 R 191 0 R 194 0 R 197 0 R 200 0 R 224 0 R 225 0 R 226 0 R 227 0 R 246 0 R] endobj 150 0 obj <>/Font<>/ProcSet[/PDF/Text]>> endobj 151 0 obj <> endobj 152 0 obj <> endobj 153 0 obj <> endobj 154 0 obj <>/F 4/FT/Tx/Ff 0/P null/Rect[90 692.398986816 198.25 706.099975585]/Subtype/Widget/T(Date)/Type/Annot/TU 203 0 R/AA<>>> endobj 155 0 obj <> endobj 156 0 obj <> endobj 157 0 obj <>stream x endstream endobj 158 0 obj <> endobj 159 0 obj <> endobj 160 0 obj <>stream x endstream endobj 161 0 obj <> endobj 162 0 obj <> endobj 163 0 obj <>stream x endstream endobj 164 0 obj <> endobj 165 0 obj <> endobj 166 0 obj <>stream x endstream endobj 167 0 obj <> endobj 168 0 obj <> endobj 169 0 obj <>stream x endstream endobj 170 0 obj <> endobj 171 0 obj <> endobj 172 0 obj <>stream x endstream endobj 173 0 obj <> endobj 174 0 obj <> endobj 175 0 obj <>stream x endstream endobj 176 0 obj <> endobj 177 0 obj <> endobj 178 0 obj <>stream x endstream endobj 179 0 obj <> endobj 180 0 obj <> endobj 181 0 obj <>stream x endstream endobj 182 0 obj <> endobj 183 0 obj <> endobj 184 0 obj <>stream x endstream endobj 185 0 obj <>/F 4/FT/Tx/Ff 0/P null/Rect[126 361.199005126 234.25 374.898986816]/Subtype/Widget/T(Date_of_Event)/Type/Annot/TU 214 0 R/AA<>>> endobj 186 0 obj <>/F 4/FT/Tx/Ff 0/P null/Rect[ 288.25 361.199005126 414.25 374.898986816]/Subtype/Widget/T(Start_Time)/Type/Annot/TU 215 0 R>> endobj 187 0 obj <>/F 4/FT/Tx/Ff 0/P null/Rect[ 464.898986816 361.199005126 558.25 374.898986816]/Subtype/Widget/T(End_Time)/Type/Annot/TU 216 0 R>> endobj 188 0 obj <> endobj 189 0 obj <> endobj 190 0 obj <>stream x endstream endobj 191 0 obj <> endobj 192 0 obj <> endobj 193 0 obj <>stream x endstream endobj 194 0 obj <> endobj 195 0 obj <> endobj 196 0 obj <>stream x endstream endobj 197 0 obj <> endobj 198 0 obj <> endobj 199 0 obj <>stream x endstream endobj 200 0 obj <> endobj 201 0 obj <> endobj 202 0 obj <>stream x endstream endobj 203 0 obj (Date) endobj 204 0 obj (Textfield) endobj 205 0 obj (Textfield0) endobj 206 0 obj (Textfield1) endobj 207 0 obj (Textfield2) endobj 208 0 obj (Textfield3) endobj 209 0 obj (Textfield4) endobj 210 0 obj (FAX) endobj 211 0 obj (Name_of_individual_requesting_services) endobj 212 0 obj (Name_of_individual_needing_services) endobj 213 0 obj (Textfield5) endobj 214 0 obj (Date_of_Event) endobj 215 0 obj (Start_Time) endobj 216 0 obj (End_Time) endobj 217 0 obj (Textfield6) endobj 218 0 obj (Contact_person_at_location) endobj 219 0 obj (Phone_Number) endobj 220 0 obj (Email_Address) endobj 221 0 obj (Signature_of_PrincipalDistrict_Department_Head) endobj 222 0 obj <> endobj 223 0 obj <> endobj 224 0 obj <>/DA(/Helv 0 Tf 0 g)/AP<>/D<>>>/T(CheckBox1)/AS/Off>> endobj 225 0 obj <>/DA(/Helv 0 Tf 0 g)/AP<>/D<>>>/T(CheckBox2)/AS/Off>> endobj 226 0 obj <>/DA(/Helv 0 Tf 0 g)/AP<>/D<>>>/T(CheckBox3)/AS/Off>> endobj 227 0 obj <>/DA(/Helv 0 Tf 0 g)/AP<>/D<>>>/T(CheckBox4)/AS/Off>> endobj 228 0 obj <>/Length 53>>stream x3TH2P0P043677R3625W(JJs*1D._ _< endstream endobj 229 0 obj <>>>/Length 114>>stream x=˻ @~bJV X1 f>~ Jr|0\ؼ`M.W|Z;pGh#X['j=qpx endstream endobj 230 0 obj <>/Length 60>>stream x337402VH2P0P043677R3625W(JJs*1D._ 9 endstream endobj 231 0 obj <>>>/Length 118>>stream x=˱ 1~bJmnBVk! )zf>~sRx*n)TxY FcE*{;aw Rb䪅Mܲpl8' endstream endobj 232 0 obj <>/Length 52>>stream x3TH2P0P043451V04гP(JJ s* D*[ ;50 endstream endobj 233 0 obj <>>>/Length 112>>stream x- P-9߾؊b-v&`!FbFPX07T~Oy3^& wX/+&wf+U-/G|n endstream endobj 234 0 obj <>/Length 59>>stream x337402VH2P0P043451V04гP(JJ s* D*[ v endstream endobj 235 0 obj <>>>/Length 116>>stream x- Q&&&hE`!0*Z*G(bᕦu|1L 9KB7?9}&6V̝9%"UXüak_5v= endstream endobj 236 0 obj <>/Length 53>>stream x3TH2P0P04351T3741V(JJs* D._ _j endstream endobj 237 0 obj <>>>/Length 114>>stream x=˱ @~bJmˮX XRL3r@b*;'e/T`l0z;=\VYg<5c l endstream endobj 238 0 obj <>/Length 60>>stream x337402VH2P0P04351T3741V(JJs* D._ 9 endstream endobj 239 0 obj <>>>/Length 119>>stream x=˱ @~bJm۽]kE;ERL3KnE:CHM}~^0UgEΘZ;]rBlN`ck''|W endstream endobj 240 0 obj <> endobj 241 0 obj <> endobj 242 0 obj <>/Length 51>>stream x3TH2P0P04ճ464Q037RE\i@qw.=S64ț勹 _" endstream endobj 243 0 obj <>>>/Length 112>>stream x=˽ @~bJӬ6(@:E< c3)iY=yvDFnvv3'-F_ endstream endobj 244 0 obj <>/Length 58>>stream x337402VH2P0P04ճ464Q037RE\i@qw.=S64ț勹 7 endstream endobj 245 0 obj <>>>/Length 116>>stream x=˱ @~bJmۻ,iE;E 1IG$&jŽ牡'$Gmn/&df.RVݾvNc${qfEƶ3~T endstream endobj 246 0 obj <>/Contents(Community Rehab\rAssociates, Inc.\r877-347-5749 - Phone\r866-547-1017 - Fax\r)/RC(Community Rehab
Associates, Inc.
877-347-5749 - Phone
866-547-1017 - Fax
)/DS(text-decoration:;font-size:12.00pt;font-family:'Times New Roman')>> endobj 247 0 obj <>stream x]{o7ߟw3X,rֹq0FJ3ȾOUlvli#pVHV"zϾ{ _z'Baa|7W䫓'^SdC%99O"8Ѭ9KN. wr /=t>_'<'OEXGhLFYbl/~\)M?T@3 Y x$[dA~z[bY|-?ۓcX,9gAjH\L gBT"J#RO#0ev槢@HJYw#8+ ^yɟ,@d/FLdM@zxr@~$LzFط?7Uju<'+^'v}?ǤÛO FR(~(E_#yd5Y@JMF&,'AQOAҹ?nlZH.xd<}D`\b#9Q ~sM}^+eγǤ_źYL+%`u-aR0GX~Mnema%&Pslva6LѫR sQrZ¼&-wr=9.g Oo+f m3b6b6,(R+bppω-!@?/^~Z[\$#ofǬ3'e%;Fz?n)UhrOA_: .Xp:b1*^f}6:Rf:-l2V4e+(\CvmSk;om/xOų^U!Y>`tf=9)5 Su!|55ՁDb>QtFDq iSPVJ\z dNy]gmQ2D4k`큼9@KWyA¤VPPQ{+Dk5TT *b2^/A/I]PCEPA%렆Ka eiLBKr@gݹ0Wdԫq[q/"S(;l;'>_= 2OYn#&@ׇ z6G~\.n>oN -\((\.T\j\j\*dPQkT5Tj~+sNQas=I#1i4%lGPQyh(^pSU*]E*]E*]CEzzJWQJ1{$Q()rccQ9;%L?l{۫ڪݖ&%p46OY~2Vvf00*v?%qq>:gd22˸! ?=y۞a돭PyQ;-c4VMuX:wOE2B,9Z; OLʁ'giMUa8f=M2YPMv"t&l(Ll=K 6 &e5 \Ӑ>$VxM$h|'!NA; 6w $hjK(}pdê1l([>h6wxSy@$ekf+g UZZEZEZCEuzzVQꎡZb:7ٜ0z(lNVYϐEǟ%eE_^28e/ЬIPQ+DJaC9Ġo0 ** *Y9x{!)ZNk}QA%룆cq^+-n