ࡱ>  |Ebjbj y?]::}}8l)FWWW((((((($+K.*)("(()}}WW)###(}8WW(#((##:*(,(Wpo/ V( ()0)`(Ru/p!u/(u/((hlJ#<6))#v)((((u/: C:  Parent, please check box if your child is 8 - 13 months oldParent, please check box if your child is 14 - 18 months old. Child's Name: Child's Birthdate: Child's Age in Months:Mother's Name: If child was premature, what was the gestational age at birth: __weeksMother's Birthdate: Zipcode of residence: Date of Form Completion:What is the primary language used in the home with the child ? (enter 1 for primary, enter 2 for secondary): ___ English ___Spanish ___ASL ___ Other (specify) _______________________________________ What is the primary mode of communication used in the home with the child? (enter 1 for primary, enter 2 for secondary): ___ gesture ___spoken language ___ spoken & signed communication ___only signed communication ___cued speech ___ emphasis on developing listening skills ___hearing aid or cochlear implant wear as much as possible What is the primary language used by the child? (enter 1 for primary, enter 2 for secondary): ___ English ___ASL or sign ___Spanish ___ too young to determine ___Other (specify) ________________________ What is the primary mode of communication used by the child? (enter 1 for primary, enter 2 for secondary): ___ gesture ___spoken language ___ spoken & signed communication ___only signed communication ___cued speech ___ emphasis on developing listening skills ___hearing aid or cochlear implant wear as much as possible __ too young to determine Where is the child in relationship to you or other caregivers during most of the time you are communicating with him/her? _____within 3 feet _____6 - 10 feet _____3 - 6 feet _____15+ feet (next room) Put a check in the box if the child appears to respond to sounds under the following conditions. If the child usually wears hearing aids or a cochlear implant, only look for responses when the amplification is on the child and you know they are working. Care should be taken that the child cannot see your movements, shadow, or feel your vibrations or moving air when you present the sounds. These items are from the Early Listening Function test that the SHINE Initial Services provider shared with you. Listening activities in quiet (no TV or radio on)6 inches3 feet6 feet10 feet15+ feet1. Mommy saying 'buh, buh, buh' quietly.2. Water running full on from kitchen faucet.3. Mommy saying 'shh, shh, shh'.4. Clapping hands together in quiet applause.5. Loud door knock using knuckles or fist. Age at which intervention services specific to hearing loss began: ______months ______ unknown Besides being at home with a parent, where does the child spend time during the day? ____ no other care providers _____ regular child care ____ hours per week; _____ regular play groups or mommy and me groups ____ times per week; _____ relative baby sits ____ hours per week; _____ other __________________________________________________ Has your child had ear infections or lengthy illnesses that have interrupted typical hearing ability or consistent use of hearing aids or cochlear implant? ___ Yes ___ No If yes, about how many weeks was your child affected during the last 6 months?____ Information to be completed by the parent What is your child's average level of hearing loss (on the audiogram add the child's responses at 500, 1000, 2000 Hz divided by 3)? Right ear _______ Left ear _______ Not enough information on audiogram to answer ________ Type of Hearing Loss: Sensorineural _____ Conductive _____ Mixed ______ Auditory Neuropathy _____ Unknown ______Check the most appropriate degree(s) of hearing loss:Mild (25-40dB)Moderate (41-55dB)Moderate-Severe (56-70dB)Severe (71-90dB)Profound (91+dB)Was any change in hearing found during follow-up hearing tests in the last 6 months? Yes No Don't Know [It is standard for infants and toddlers to receive hearing tests every 3 months]Right EarLeft EarIs amplification worn daily? Yes No If amplification is worn daily, approximately how many hours per day does your child have the hearing aids or cochlear implant on and working? ___hrs/dayIf amplification is not worn daily, is it worn occasionally? Yes No If yes, about how many hours per week are the working hearing aids or cochlear implant worn by the child? ____hrs/weekPlease indicate what kind(s) of amplification your child wears (check as many as appropriate). ______linear/analog hearing aids ______FM system ______bone conduction hearing aid _______ dont know ______programmable/digital hearing aids ______cochlear implant ______ other ___________________Etiology What was the primary cause of the childs hearing loss? a. Congenital ___ CMV or other prenatal infection ____ Hereditary ____Prematurity ____Connexin 26 ___ Rh Incompatibility ____Maternal Rubella b. Acquired: ___ Infection ____Measles/Mumps ___Ototoxicity ____High Fever ___Meningitis ___Trauma c. Syndrome: ___ Down ___Goldenhar ___Treacher Collins ___ Ushers ___Waardenburg d. Unknown ___ ___ Other (specify)_____________________________________________________________ To be completed by Service Coordinator or Teacher of Deaf/Hard of HearingChilds unique EIP identification number: . EIP Center Number: __________________Age in months at time of confirmation of hearing loss by an audiologist (not hearing screening failure performed at hospital). This date should be within 2 days prior to referral to Help Me Grow. ______monthsAge in months when one or both hearing aids were first fit to child (includes loaner hearing aids). ______months If the child received a cochlear implant, how many months old was the child at the time of implantation? ______monthsWhat has been the intensity and type of services received by the child in the last 6 months? Type of services and hours/wk: Type: ___ speech ____ OT ____ PT ____ dev. teacher ____SKI*HI/INSITE ____DHH ____ Aud Verbal ____other Hours/wk ____ ____ ____ ____ ____ ____ ____ ____How involved are caregivers in early intervention and actively providing communication access accommodations to child? 1= Need to develop 2= Fair/Improving 3= Pretty Good 4= Good 5= Excellent a) Regular early intervention session attendance ____ b) Requesting/pursuing information ____ c) Quality of daily language models ____ d) Quality of turn taking with child ____ e) Motivation to actively assist child development ____ f) Level of support outside the family ____ g) Parent ability to advocate with others for their childs needs ____What are the current services provided to the child (check all that apply)? ___ home based program for children with hearing loss ___ home based program for children with special needs ___ center-based services (clinic/school) for children with hearing loss ___ center-based services (clinic/school) for children with special needs ___ center-based preschool/toddler program, children with hearing loss ___ center-based preschool/toddler program, children with special needsFrequency of scheduled visits: __ 1x/wk __2x/wk __2 wks/mo __ 1x/mo __ other __ 1x/wk __2x/wk __2 wks/mo __ 1x/mo __ other __ 1x/wk __2x/wk __2 wks/mo __ 1x/mo __ other __ 1x/wk __2x/wk __2 wks/mo __ 1x/mo __ other __ 1x/wk __2x/wk __2 wks/mo __ 1x/mo __ other __ 1x/wk __2x/wk __2 wks/mo __ 1x/mo __ other Does the child receive related services? ___ Yes ___ No If yes, check all related services regularly received: ___audiology ___physical therapy ___occupational therapy ___speech therapy ___auditory verbal therapy ___mental health ___vision ___home health ___ Other (specify)__________________________________________ PART ONE VOCABULARY CHECKLISTF For words your child understands the sign for but does not yet say, mark the first column (understands sign). For words your child understands the word for but does not yet say, mark the second column (understands word). For words that your child not only understands but also signs, mark the third column (understands and signs). Finally, for words that your child not only understands but also says, mark the fourth column (understands and says). If your child uses a different pronunciation of a word, mark it anyway. Under-stands signsUnder-stands wordsUnder-stands and signsUnder-stands and saysUnder-stands signsUnder-stands wordsUnder-stands and signsUnder-stands and saysUnder-stands signsUnder-stands wordsUnder-stands and signsUnder-stands and sayschoo choochairwaitmeowcouchbreakouchkitchenfeeduh ohtablefinishbirdtelevisionhelpdogblanketjumpduckbottlekickkittycupkissliondishpushmouselampsingcarradiosmilestrollerspoonnightballflowertodaybookhomeall gonedollmoonbigbreadoutsidebrokencandyplantdarkcerealrainfastcookierockhurtjuicewaterprettytoastbabysittersofthatgirlIpantsgrandmameshoemommyhowsockbathwhoeyedon tawayheadhioutlegnight nightothernosepatty cakesometoothpleaseColumn TotalColumn TotalColumn TotalTotal Number of Words Said/SignedTotal Number or Words UnderstoodTotal Number of Words Said/Signed that were not marked as Words UnderstoodTotal Vocabulary ProductionTotal Vocabulary ComprehensionStep 1: Total all columns and enter totals in blanks above for Column Totals. Step 2: Obtain the Total Vocabulary Production Score by counting the total number of words the child understands and says or understands and signs. Each word can only be counted once for vocabulary production, whether the child signs the word, says the word, or can do both. Step 3: Counting the total number of words the child understands signs or understands words. Each word can only be counted once for vocabulary comprehension, whether the child understands the sign for the word, or understands the spoken word, or can do both. Next, because a child that can produce a word is assumed to understand a word, count the total number of any words that are indicated in the says/signs column if these words are not already counted in the understands signs / words columns. Add these numbers together to calculate the childs Total Vocabulary Comprehension Score.  PART II ACTIONS AND GESTURES A. FIRST COMMUNICATIVE GESTURESWhen infants are first learning to communicate, they often use gestures to make their wishes known. For each item below, mark the line that describes your child's actions right now.Not yet SometimesOften1. Extends arm to show you something he /she is holding.2. Reaches out and gives you a toy or some object that he/she is holding.3. Points (with arm and index finger extended) at some interesting object or event.4. Waves bye-bye on his/her own when someone leaves.5. Extends his/her arm upward to signal a wish to be picked up.6. Shakes head "no".7. Nods head "yes".8. Gestures "hush" by placing finger to lips.9. Requests something by extending arm and opening and closing hand.10. Blows kisses from a distance.11. Smacks lips in a "yum yum" gesture to indicate that something taste good.12. Shrugs to indicate "all gone" or "where'd it go". B. GAMES AND ROUTINESDoes your child do any of the following?YesNo1. Play peekaboo.2. Play patty cake.3. Play "so big".4. Play chasing games.5. Sing.6. Dance. C. ACTIONS WITH OBJECTSDoes your child do or try to do any of the following?YesNo1. Eat with a spoon or fork.2. Drink from a cup containing liquid.3. Comb or brush own hair.4. Brush teeth.5. Wipe face or hands with a towel or cloth.6. Put on hat.7. Put on a shoe or sock.8. Put on a necklace, bracelet, or watch.9. Lay head on hands and squeeze eyes shut as if sleeping.10. Blow to indicate something is hot.11. Hold plane and make it "fly".12. Put telephone to ear.13. Sniff flowers.14. Push toy car or truck.15. Throw a ball.-:?mn| Y [ n;d356:!!$$$$еݰݰݰݰݰݰݪݰݰݰݡݰݔݔht$hA5CJ\ht$5CJ\ hACJ hA>*hA5CJ\hA5CJ\hA5CJ \ hA5\ hACJ hAhA5CJ\ hACJjhACJUmHnHu:?@ABCDVP$IfIkd$$Iflp0}#   ?64 laIkd$$Ifl 0}#     ? 64 la $$Ifa$ $$Ifa$$a$ x$&`#$./Ifb$$a$Gkd $$Ifl0}#     ? 64 la- zeex$&`#$./Ifb$kd$$Ifs    0(4 6`0    ;)44 sae4- . C zaLx$&`#$./Ifb$ !x$&`#$./Ifb$kdN$$Ifs    0(4 6`0    ;)44 sae4 Z [ ztit  !$If$Ifkd$$Ifs    0(4 6`0    ;)44 sae4[ \ Y 8[kdD$$IflZ)|)064 la  !$If$If[kd$$IflZ)|)064 la )  8[kd$$IflZ)|)064 la  !$If$If89:6[kd$$IflZ)|)064 la $$Ifa$x$If[kdL$$IflZ)|)064 laFOV]en $$Ifa$$If]kdT$$IflZ)|)0|)64 lax$Ifno@:::::$Ifkd$$IflֈZ^t"%)r80|)64 la:kd$$IflֈZ^t"%)r80|)64 la$If:kd$$IflֈZ^t"%)r80|)64 la$If'(:kd $$IflֈZ^t"%)r80|)64 la$If()*+,-X:kd $$IflֈZ^t"%)r80|)64 la$IfXYZ[\]^:kd $$IflֈZ^t"%)r80|)64 la$If^_:0129[kd $$IflZ)|)064 la  !$If$If9:;f !xx$& #$/Ifb$[kd $$IflZ)|)064 lafgWXzzz !$& #$/Ifb$okd $$Ifs    +,   6 0    ,644 sae4 %/?uZ?Z?Z$  x$& #$/Ifa$b$$ ! $& #$/Ifa$b$  x$& #$/Ifb$qkdG$$Ifs     +,  6 0    ,644 sae4?IPZck3  x$& #$/Ifb$x$& #$/Ifb$$ v x$& #$/Ifa$b$$ ! $& #$/Ifa$b$$  x$& #$/Ifa$b$34kd$$Ifs4    ֞/ u]!+!  F H `    6 0    ,644 sae4f44>?@ABCD ! x$& #$/Ifb$  x$& #$/Ifb$  x$& #$/Ifb$DEkd$$Ifs4    ֞/ u]!+!  F H     6 0    ,644 sae4f4ENOPQRST  x$& #$/Ifb$  x$& #$/Ifb$TUkd$$Ifs4    ֞/ u]!+!    F   H        6 0    ,644 sae4f4U'g?@5kd$$Ifs    0+         6 0    ,644 sae4 !x$& #$/Ifb$xx$& #$/Ifb$ !x$& #$/Ifb$@-bD6iaa$#$Ifokd$$Ifs    +,     6 0    ,644 sae4x$& #$/Ifb$x$& #$/Ifb$ 6789:m$ !$&`#$/Ifa$b$ !qkdq$$Ifs    +,   6 0    ,644 sae4{ !xx$&`#$/Ifb$jkd/$$Ifs    '( 6`0    644 sae4x !dhxx$&`#$/Ifb$jkd$$Ifs    '( 6`0    644 sae4[ {{ !xx$&`#$/Ifb$jkdk$$Ifs    '( 6`0    644 sae4 U!!Y"{{{ !xx$&`#$/Ifb$jkd $$Ifs    '( 6`0    644 sae4Y"Z"")#${{{ !xx$&`#$/Ifb$jkd$$Ifs    '( 6`0    644 sae4$$$%K%%%%&m&&&&"'T'''  !$If$IfjkdE$$Ifs    '( 6`0    644 sae4'''1(()~sss  !$If $ !$Ifa$skd$$Ifl0B)064 la $)))) );)<)L+M+N+,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,----- - ----- -"-$-&-(-*-6-8-:-<->-@-B-D-F-H-R-T-V-X-Z-\-^-`-b-r-t-v-x-z-hAmH ,sH , hACJ hACJhAOJQJ^J hA5CJ hACJ(hAR)))))4+ $ !a$`kd$$Ifl")(06Z4 la   !$If`kd}$$Ifl")(06Z4 la ) );)<)L+dH$&`#$/If]^H`b$hkd$$Ifl    P* 6`0    64 lae4 $&`Ifb$ $ !a$L+M+N+O+P+c+v++++}}iiii}$$&`#$/Ifa$b$$&`#$/Ifb$ $ !a$hkd.$$Ifl    * 6`0    64 lae4 ++++++,<,j,,,,,,,,,,,,,,,Ff$&`#$/Ifb$$$&`#$/Ifa$b$$$&`#$/If]a$b$,,,,,,-- ----"-&-*-6-:->-B-F-H-R-V-Z-^-Ff*$&`#$/Ifb$Ff$$$&`#$/Ifa$b$^-b-r-v-z-~--------------------Ff#1$&`#$/Ifb$$$&`#$/Ifa$b$z-|-~-----------------------------------------..... . ...&.(.*.,...0.2.4.6.@.B.D.F.H.J.L.N.P.R.Z.\.^.`.b.d.f.h.j.z.|.~........... hACJ hACJhAhAmH ,sH ,\-----... ..&.*...2.6.@.D.H.L.P.R.Z.^.b.f.Ff=$&`#$/Ifb$Ff\7$$&`#$/Ifa$b$f.j.z.~......................FfC$&`#$/Ifb$$$&`#$/Ifa$b$...................................// / /////// /"/$/&/(/*/,/./8/://@/B/D/F/H/J/T/V/X/Z/\/^/`/b/d/n/p/r/t/v/x/z/|/~///////////// hACJ hACJhAmH ,sH ,hA\...../ /////"/&/*/./8/0P0R0T0V0X0Z0\0^0`0l0n0p0r0t0v0x0z0|000000000000000000000 hACJ hACJhAmH ,sH ,hA\////////000000 0,0004080<0>0P0T0X0\0Ffb$&`#$/Ifb$Ff\$$&`#$/Ifa$b$\0`0l0p0t0x0|0000000000000000000Ff$i$&`#$/Ifb$$$&`#$/Ifa$b$000000000000000000000011111 1111111 1"1$16181:1<1>1@1B1D1F1H1R1T1V1X1Z1\1^1`1b1l1n1p1r1t1v1x1z1|11111111111111111111111111111 hACJ hACJhAhAmH ,sH ,\000000011 1111 1$161:1>1B1F1H1R1V1Z1^1Ffu$&`#$/Ifb$Ff]o$$&`#$/Ifa$b$^1b1l1p1t1x1|1111111111111111111Ff{$&`#$/Ifb$$$&`#$/Ifa$b$11111111111122222 2 22222 2"2$2&2(2*2426282:2<2>2@2B2D2F2T2V2X2Z2\2^2`2b2d2n2p2r2t2v2x2z2|2~2222222222222222222222222222222222222 hACJhAhAmH ,sH , hACJ\11111122 2222"2&2*24282<2@2D2F2T2X2\2`2Ff$&`#$/Ifb$Ff$$&`#$/Ifa$b$`2d2n2r2v2z2~2222222222222222222Ff $&`#$/Ifb$$$&`#$/Ifa$b$222222233 3333"3&34383<3@3D3F3R3V3Z3^3Ff8$&`#$/Ifb$Ff$$&`#$/Ifa$b$22222233333 333333 3"3$3&3436383:3<3>3@3B3D3F3R3T3V3X3Z3\3^3`3b3x3z3|3~33333333333333333333333333333333333333333333333344hAmH ,sH , hACJ hACJhA\^3b3x3|3333333333333333333333Ffq$&`#$/Ifb$$$&`#$/Ifa$b$333333344444 4$4(4.42464:4>4@4J4N4R4V4Ff$&`#$/Ifb$Ff$$&`#$/Ifa$b$44444444 4"4$4&4(4.40424446484:4<4>4@4J4L4N4P4R4T4V4X4Z4f4h4j4l4n4p4r4t4v4~444444444444444444444444444444444444444444444445555 5 hACJ hACJhAmH ,sH ,hA\V4Z4f4j4n4r4v4~444444444444444444Ff$&`#$/Ifb$$$&`#$/Ifa$b$444444444455 5555 5$5(5,5.585<5@5D5Ff$&`#$/Ifb$FfU$$&`#$/Ifa$b$ 5 555555 5"5$5&5(5*5,5.585:5<5>5@5B5D5F5H5N5P5R5T5V5X5Z5\5^5f5h5j5l5n5p5r5t5v5x5555555555555555555555555555555555555566 6 666666 6"6$6&6 hACJ hACJhAhAmH ,sH ,\D5H5N5R5V5Z5^5f5j5n5r5v5x5555555555555Ff$&`#$/Ifb$$$&`#$/Ifa$b$55555555556 6666 6$6(6,60626>6B6F6J6FfG$&`#$/Ifb$Ff$$&`#$/Ifa$b$&6(6*6,6.60626>6@6B6D6F6H6J6L6N6\6^6`6b6d6f6h6j6l6n6v6x666666666666 7"7$7&7R7f7h7j7788888=8>8?8@88&9ͽͽٞٽ hACJ\hA5CJOJQJ\^JhACJOJQJ^JmH ,sH ,hACJOJQJ^JmH ,sH ,hACJOJQJ^JhA5CJOJQJ\^J hACJ hACJhAmH ,sH ,hA:J6N6\6`6d6h6l6n6p6r6t6v6x6666666666666Ff$&`#$/Ifb$$$&`#$/Ifa$b$66666$7&7h7j788888>8?8Ff$&`#$/Ifb$$IfFf|$$&`#$/Ifa$b$?8@8!kd$$IfTs4    \ "n'+ fn    6`(0    4H4ae4f4p(T@889<<<<<<OFFFF $ !a$tkd$$IfTs4    +  6`0    4H4ae4f4T$&`#$/Ifb$x$&`#$/If]b$x$&`#$/Ifb$&9'9(92939K9999 :-:&;e;h;;;<<$<D<<=>>>>> >>>>>>>\?^?`?b?d?f???????f@h@j@l@n@p@@@@@@@@@@@@@DAFAHAJALANAAAAAݺݺݺݺݺݺݺݺݺݺݺݺݺݺݺݺݺݺݺݺݺݺݺݺݺݺhAmH ,sH ,hA5CJaJ hA5\ hA5CJhA hACJ hA5CJ hACJ\ hACJhA5CJ\I<#<$<D<E<<===|hhh$ *"' $If^ a$$ *"'$If]a$ckd$$Ifl4 0**   04 laf4$If$a$==O=>> >bUEEE$ #($Ifa$ #($Ifkdi$$Ifl4\  %0*z  04 laf4 >>>>>>bUEEE$ #($Ifa$ #($Ifkd$$Ifl4\  %0*z  04 laf4>>\?2% #($Ifkd$$Ifl4\  %0*z   (04 laf4p(\?`?d?h?j????RE #($Ifkd$$Ifl4\  %0*z  04 laf4$ #($Ifa$???"kd$$$Ifl4\  %0*z   (04 laf4p($ #($Ifa$?f@j@n@r@t@@@Ekd$$Ifl4\  %0*z  04 laf4$ #($Ifa$ #($If@@@@"kd$$Ifl4\  %0*z   (04 laf4p($ #($Ifa$@@@@@@DAHAEkd$$Ifl4\  %0*z  04 laf4$ #($Ifa$ #($IfHALAPARA"kd*$$Ifl4\  %0*z   (04 laf4p($ #($Ifa$RAAAAAA2B6BEkd$$Ifl4\  %0*z  04 laf4$ #($Ifa$ #($IfAAA2B4B6B8B:B* hA5CJ hA5CJ hACJ hA5\hAhAmH ,sH , hACJO6B:B>B@B"kd$$Ifl4\  %0*z   (04 laf4p($ #($Ifa$@BBBBBBZC^CEkd$$Ifl4\  %0*z  04 laf4$ #($Ifa$ #($If^CbCfChC"kd0$$Ifl4\  %0*z       (04 laf4p($ #($Ifa$hCjCCCCCCxx$ #'$Ifa$ #'$Ifckd$$Ifl4 0**   04 laf4$IfCC D$D(DuiUU$ p#'$If^a$ p#'$Ifkd]$$Ifl4QF"R&0*t" 8 0    4 laf4(D*DTDXD\DuiUU$ p#'$If^a$ p#'$Ifkd|$$Ifl4 F"R&0*t" 8 0    4 laf4\D^DDDDPD00$ p#'$If^a$ p#'$Ifkd$$Ifl4F"R&0*t" 8  0    4 laf4pDDDDDuiUU$ p#'$If^a$ p#'$Ifkd$$Ifl4F"R&0*t" 8 0    4 laf4DDDDDPD00$ p#'$If^a$ p#'$Ifkd$$Ifl4F"R&0*t" 8  0    4 laf4pDDDEEuiUU$ p#'$If^a$ p#'$Ifkd| $$Ifl4F"R&0*t" 8 0    4 laf4EEE:EPNH$Ifkd $$Ifl4 F"R&0*t"  8    0    4 laf4p:E4@4F4H4L4N444444444555 5T5V5X5Z55555666686:6<6>6f6h6j6l66666:7<7>7@7h7j7 hA5CJ hA5CJ hACJ hA>*CJ hA5\hA hACJhAmH ,sH ,P1111122TA p#'$r&`#$/IfkdY,$$Ifl4F"%*" 8  6`r0    4 laf4$ p#'$r&`#$/If^a$2202H5 p#'$r&`#$/Ifkdz-$$Ifl4F"%*" 8   6`r0    4 laf4p024282:2222TA p#'$r&`#$/Ifkd.$$Ifl4F"%*" 8  6`r0    4 laf4$ p#'$r&`#$/If^a$222H5 p#'$r&`#$/Ifkd0$$Ifl4F"%*" 8   6`r0    4 laf4p2222333TA p#'$r&`#$/Ifkds1$$Ifl4F"%*" 8  6`r0    4 laf4$ p#'$r&`#$/If^a$3 3F3H5 p#'$r&`#$/Ifkd2$$Ifl4F"%*" 8   6`r0    4 laf4pF3J3N3P33TN$Ifkd4$$Ifl4 F"%*"   8   6`r0    4 laf4$ p#'$r&`#$/If^a$33@4H4N4||$ #'$If^a$ #'$Ifckd/5$$Ifl4 0**   04 laf4N4P4444uiRR$ p#'!$If^`!a$ p#'$Ifkd5$$Ifl4?F)"&0*" ) 0    4 laf444444uiRR$ p#'!$If^`!a$ p#'$Ifkd7$$Ifl4 F)"&0*" ) 0    4 laf44455"5PD--$ p#'!$If^`!a$ p#'$Ifkd&8$$Ifl4 F)"&0*" )  0    4 laf4p"5$5T5X5\5uiRR$ p#'!$If^`!a$ p#'$Ifkd9$$Ifl4 F)"&0*" ) 0    4 laf4\5^5555PD--$ p#'!$If^`!a$ p#'$Ifkd:$$Ifl4 F)"&0*" )  0    4 laf4p55666uiRR$ p#'!$If^`!a$ p#'$Ifkd<$$Ifl4 F)"&0*" ) 0    4 laf46 686<6@6PD--$ p#'!$If^`!a$ p#'$Ifkd=$$Ifl4 F)"&0*" )  0    4 laf4p@6B6f6j6n6uiRR$ p#'!$If^`!a$ p#'$Ifkdz>$$Ifl4 F)"&0*" ) 0    4 laf4n6p6666PD--$ p#'!$If^`!a$ p#'$Ifkd?$$Ifl4 F)"&0*" )  0    4 laf4p66:7>7B7uiRR$ p#'!$If^`!a$ p#'$Ifkd@$$Ifl4 F)"&0*" ) 0    4 laf4B7D7h7l7p7PD--$ p#'!$If^`!a$ p#'$Ifkd B$$Ifl4 F)"&0*" )  0    4 laf4pj7l7n777778888L8N8P8R888888888>9x9z9&:(:l;;;4<<<.=====>>d?r???d@t@nAAAAAAAAAAAAAAAAAAܷܿܿ hA0JjhA0JUh|Nfjh|NfU hAH*hA5>*\hA5CJ\ hA5\hAhA5CJ\ht$5CJ\hAmH ,sH , hACJ@p7r7777uiRR$ p#'!$If^`!a$ p#'$IfkdlC$$Ifl4 F)"&0*" ) 0    4 laf477888PD--$ p#'!$If^`!a$ p#'$IfkdD$$Ifl4 F)"&0*" )  0    4 laf4p88L8P8T8uiRR$ p#'!$If^`!a$ p#'$IfkdE$$Ifl4 F)"&0*" ) 0    4 laf4T8V8888PD--$ p#'!$If^`!a$ p#'$IfkdF$$Ifl4 F)"&0*" )  0    4 laf4p888u]$ !$g&`#$/Ifa$b$kd^H$$Ifl4 F)"&0*"   )  0    4 laf488z9&:tt !$g&`#$/Ifb$ukdI$$Ifs4    ?** 6`g0    *44 s4+ae4f4&:(:*::$;N;l;ydMM<<$g&`#$/Ifb$ !x$g&`#$/Ifb$ !$g&`#$/Ifb$kd3J$$Ifs    0-?* 6`g0    *44 s4+ae4l;;;<4<z<<<<"==>d?d@AA !$g&`#$/Ifb$ !%x$g&`#$/Ifb$ !xx$g&`#$/Ifb$ !x$g&`#$/Ifb$$g&`#$/Ifb$AAAAAAAAAAAAztrrrrrrrri&`#$ !kdJ$$Ifs     0-?* 6`g0    *44 s4+ae4 AAA.CDCFCHCDDDD.E0EvExEzE$a$&$$d %d &d 'd N O P Q a$#$d %d &d 'd N O P Q  $dN $$d N a$ $d N ABBBBB(C*C.C0CC@CBCDCHC"D$DDDDDDDDDE$E.E0EvE|EƵ~x hACJ hACJ hA5OJQJ\^Jht$5OJQJ\^Jh|NfjLhA>*CJUhAh00JmHnHu hA0JjhA0JUhA0JCJjKhA>*CJU hA>*CJjhA>*CJU hACJzE|E !w 0&P+pw,pm-p`.pz /R / =!"#$% 45m6<7z $$If!vh5 5?#v #v?:V l 6,5 5?/  /  4a}$$If!vh5 5?#v #v?:V lp6,5 5?/  4a$$If!vh5 5?#v #v?:V l6,5 5?/  /  4a$$If!vh554#v#v4:V s 6`0    ;)55444 se4$$If!vh554#v#v4:V s 6`0    ;)55444 se4$$If!vh554#v#v4:V s 6`0    ;)55444 se4$$If!vh5|)#v|):V l065|)4a$$If!vh5|)#v|):V l065|)4a$$If!vh5|)#v|):V l065|)4a$$If!vh5|)#v|):V l065|)4a$$If!vh5|)#v|):V l065|)4a}$$If!vh5|)#v|):V l0|)65|)4a$$If!vh5r558555#vr#v#v8#v#v#v:V l0|)6,5r5585554a$$If!vh5r558555#vr#v#v8#v#v#v:V l0|)65r5585554a$$If!vh5r558555#vr#v#v8#v#v#v:V l0|)65r5585554a$$If!vh5r558555#vr#v#v8#v#v#v:V l0|)65r5585554a$$If!vh5r558555#vr#v#v8#v#v#v:V l0|)65r5585554a$$If!vh5r558555#vr#v#v8#v#v#v:V l0|)65r5585554a$$If!vh5|)#v|):V l065|)4a$$If!vh5|)#v|):V l065|)4a$$If!vh5,#v,:V s 6 0    ,65,/  /  44 se4$$If!vh5,#v,:V s  6 0    ,65,/  / 44 se4$$If!vh5!55F55H55 #v!#v#vF#v#vH#v#v :V s4 6 0    ,6+5!55F55H55 /  /  / /  /  / / / / / /  / /  /  44 se4f4$$If!vh5!55F55H55 #v!#v#vF#v#vH#v#v :V s4 6 0    ,6+5!55F55H55 /  /  / /  /  / / / / / /  /  /  44 se4f4$$If!vh5!55F55H55 #v!#v#vF#v#vH#v#v :V s4 6 0    ,6+5!55F55H55 /  /  / /  /  /  /  / / / /  /  /  /  44 se4f4$$If!vh55#v#v:V s 6 0    ,655/  /  /  /  44 se4$$If!vh5,#v,:V s 6 0    ,65,/  /  44 se4$$If!vh5,#v,:V s 6 0    ,65,/  /  44 se4$$If!vh5(#v(:V s 6`0    65(44 se4$$If!vh5(#v(:V s 6`0    65(44 se4$$If!vh5(#v(:V s 6`0    65(44 se4$$If!vh5(#v(:V s 6`0    65(44 se4$$If!vh5(#v(:V s 6`0    65(44 se4$$If!vh5(#v(:V s 6`0    65(44 se4$$If !vh55#v#v:V l06554a $$Ifz!vh5(#v(:V l06Z5(4a $$Ifz!vh5(#v(:V l06Z5(4a $$If!vh5+#v+:V lP 6`0    6,54e4$$If!vh5+#v+:V l 6`0    6,54e4$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s  6`0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k5/  44H4ae4Tkd$$IfTs     N "9Oh!K$n'+  M R j f W    e  P N k   6`0    <<<<4H4ae4T$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s 6`0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4Tkd"$$IfTs    N "9Oh!K$n'+ MRjfWePNk 6`0    <<<<4H4ae4TA$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s  6`֖0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4p֖TGkd'$$IfTs    N "9Oh!K$n'+ MRjfWePNk  6`֖0    <<<<4H4ae4p֖T$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s 6`0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4Tkd3/$$IfTs    N "9Oh!K$n'+ MRjfWePNk 6`0    <<<<4H4ae4TA$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s  6`֖0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4p֖TGkd4$$IfTs    N "9Oh!K$n'+ MRjfWePNk  6`֖0    <<<<4H4ae4p֖T$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s 6`0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4Tkd;$$IfTs    N "9Oh!K$n'+ MRjfWePNk 6`0    <<<<4H4ae4TA$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s  6`֖0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4p֖TGkd@$$IfTs    N "9Oh!K$n'+ MRjfWePNk  6`֖0    <<<<4H4ae4p֖T$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s 6`0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4TkdH$$IfTs    N "9Oh!K$n'+ MRjfWePNk 6`0    <<<<4H4ae4TA$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s  6`֖0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4p֖TGkdL$$IfTs    N "9Oh!K$n'+ MRjfWePNk  6`֖0    <<<<4H4ae4p֖T$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s 6`0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4TkdT$$IfTs    N "9Oh!K$n'+ MRjfWePNk 6`0    <<<<4H4ae4TA$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s  6`֖0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4p֖TGkdoY$$IfTs    N "9Oh!K$n'+ MRjfWePNk  6`֖0    <<<<4H4ae4p֖T$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s 6`0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4Tkd`$$IfTs    N "9Oh!K$n'+ MRjfWePNk 6`0    <<<<4H4ae4TA$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s  6`֖0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4p֖TGkde$$IfTs    N "9Oh!K$n'+ MRjfWePNk  6`֖0    <<<<4H4ae4p֖T$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s 6`0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4Tkdmm$$IfTs    N "9Oh!K$n'+ MRjfWePNk 6`0    <<<<4H4ae4TA$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s  6`֖0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4p֖TGkdSr$$IfTs    N "9Oh!K$n'+ MRjfWePNk  6`֖0    <<<<4H4ae4p֖T$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s 6`0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4Tkdy$$IfTs    N "9Oh!K$n'+ MRjfWePNk 6`0    <<<<4H4ae4TA$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s  6`֖0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4p֖TGkd~$$IfTs    N "9Oh!K$n'+ MRjfWePNk  6`֖0    <<<<4H4ae4p֖TA$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s  6`֖0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4p֖TGkdQ$$IfTs    N "9Oh!K$n'+ MRjfWePNk  6`֖0    <<<<4H4ae4p֖TA$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s  6`֖0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4p֖TGkdݍ$$IfTs    N "9Oh!K$n'+ MRjfWePNk  6`֖0    <<<<4H4ae4p֖TA$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s  6`֖0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4p֖TGkdi$$IfTs    N "9Oh!K$n'+ MRjfWePNk  6`֖0    <<<<4H4ae4p֖TA$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s  6`֖0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4p֖TGkd$$IfTs    N "9Oh!K$n'+ MRjfWePNk  6`֖0    <<<<4H4ae4p֖T$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s 6`0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4Tkd$$IfTs    N "9Oh!K$n'+ MRjfWePNk 6`0    <<<<4H4ae4TA$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s  6`֖0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4p֖TGkdg$$IfTs    N "9Oh!K$n'+ MRjfWePNk  6`֖0    <<<<4H4ae4p֖T$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s 6`0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4Tkd$$IfTs    N "9Oh!K$n'+ MRjfWePNk 6`0    <<<<4H4ae4TA$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s  6`֖0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4p֖TGkdٵ$$IfTs    N "9Oh!K$n'+ MRjfWePNk  6`֖0    <<<<4H4ae4p֖T$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s 6`0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4Tkde$$IfTs    N "9Oh!K$n'+ MRjfWePNk 6`0    <<<<4H4ae4TA$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s  6`֖0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4p֖TGkdK$$IfTs    N "9Oh!K$n'+ MRjfWePNk  6`֖0    <<<<4H4ae4p֖T$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s 6`0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4Tkd$$IfTs    N "9Oh!K$n'+ MRjfWePNk 6`0    <<<<4H4ae4TA$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s  6`֖0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k544H4ae4p֖TGkd$$IfTs    N "9Oh!K$n'+ MRjfWePNk  6`֖0    <<<<4H4ae4p֖T$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s 6`0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k5/ 44H4ae4TkdI$$IfTs    N "9Oh!K$n'+ MRjfWePNk 6`0    <<<<4H4ae4T]$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s  6`֖0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k5/ /  44H4ae4p֖TGkd=$$IfTs    N "9Oh!K$n'+  M R j f W    e  P N k    6`֖0    <<<<4H4ae4p֖T$$If@!vh5P555!555y5;5 l5 5 25 5 5 #5#vP#v#v#v!#v#v#vy#v;#v l#v #v 2#v #v #v ##v:V s  6`֖0    ,5 5M5R5j5f5W555 5 e5 5 P5 N5 k5/ / / /  /  / 44H4ae4p֖TGkd$$IfTs    N "9Oh!K$n'+  M R j f W    e  P N k     6`֖0    <<<<4H4ae4p֖T$$If@!vh5= 55 55 5#v= #v#v #v#v #v:V s4  6`<0    ,55f55e55/  / / / / / /  44H4ae4f4p<T1kd$$IfTs4    ֈ "9On'+ fe   6`<0    4H4ae4f4p<T$$If@!vh5= 55L5#v= #v#vL#v:V s4  6`(0    ,55f5n 5/  /  / / / / /  44H4ae4f4p(T$$If@!vh55+#v5+:V s4 6`0    ,5/ /  44H4ae4f4T$$If!vh5*#v*:V l4 0,5*/  / 4af4$$If!vh5z555#vz#v:V l40,5z5/  /  / / / / /  4af4$$If!vh5z555#vz#v:V l40,,5z5/  /  / / / / /  4af4p$$If!vh5z555#vz#v:V l4 (0,,5z5/  /  / / / /  4af4p($$If!vh5z555#vz#v:V l40,,5z5/  /  / / / /  4af4p$$If!vh5z555#vz#v:V l4 (0,,5z5/  /  / / / /  4af4p($$If!vh5z555#vz#v:V l40,,5z5/  /  / / / /  4af4p$$If!vh5z555#vz#v:V l4 (0,,5z5/  /  / / / /  4af4p($$If!vh5z555#vz#v:V l40,,5z5/  /  / / / /  4af4p$$If!vh5z555#vz#v:V l4 (0,,5z5/  /  / / / /  4af4p($$If!vh5z555#vz#v:V l40,,5z5/  /  / / / /  4af4p$$If!vh5z555#vz#v:V l4 (0,,5z5/  /  / / / /  4af4p($$If!vh5z555#vz#v:V l40,,5z5/  /  / / / /  4af4~$$If!vh5z555#vz#v:V l4 (0,,5z5/  /  / / / /  /  4af4p($$If!vh5*#v*:V l4 0,5*/  / 4af4$$If!vh5t"585#vt"#v8#v:V l4Q0,5t"585/  /  / / / / /  4af4#$$If!vh5t"585#vt"#v8#v:V l4 0,,5t"585/  /  / / / / /  4af4`$$If!vh5t"585#vt"#v8#v:V l4 0,,5t"585/  /  / / / /  4af4p$$If!vh5t"585#vt"#v8#v:V l40,,5t"585/  /  / / / /  4af4`$$If!vh5t"585#vt"#v8#v:V l4 0,,5t"585/  /  / / / /  4af4p$$If!vh5t"585#vt"#v8#v:V l40,,5t"585/  /  / / / /  4af4n$$If!vh5t"585#vt"#v8#v:V l4  0,,5t"585/  /  / / / /  /  4af4p$$If!vh5*#v*:V l4 0,5*/  / 4af4#$$If!vh5"5 5#v"#v #v:V l4l0,,5"5 5/  /  / / / / /  4af4$$If!vh5"5 5#v"#v #v:V l40,5"5 5/  /  / / / / /  4af4Z$$If!vh5"5 5#v"#v #v:V l4 0,5"5 5/  /  / / / /  4af4p+$$If!vh5"5 5#v"#v #v:V l40,5"5 5/  / / / / / / /  4af4v$$If!vh5"5 5#v"#v #v:V l4 0,5"5 5/  /  / / / / / /  4af4p$$If!vh5"5 5#v"#v #v:V l40,5"5 5/  /  / / / /  4af4Z$$If!vh5"5 5#v"#v #v:V l4 0,5"5 5/  /  / / / /  4af4p$$If!vh5"5 5#v"#v #v:V l40,5"5 5/  /  / / / /  4af4Z$$If!vh5"5 5#v"#v #v:V l4 0,5"5 5/  /  / / / /  4af4p$$If!vh5"5 5#v"#v #v:V l40,5"5 5/  /  / / / /  4af4h$$If!vh5"5 5#v"#v #v:V l4 0,5"5 5/  /  /  / / / /  4af4p$$If!vh5"5 5#v"#v #v:V l40,5"5 5/  /  /  / / / /  4af4Z$$If!vh5"5 5#v"#v #v:V l4 0,5"5 5/  /  / / / /  4af4p$$If!vh5"5 5#v"#v #v:V l40,5"5 5/  /  / / / /  4af4Z$$If!vh5"5 5#v"#v #v:V l4 0,5"5 5/  /  / / / /  4af4p$$If!vh5"5 5#v"#v #v:V l40,5"5 5/  /  / / / /  4af4Z$$If!vh5"5 5#v"#v #v:V l4 0,5"5 5/  /  / / / /  4af4p$$If!vh5"5 5#v"#v #v:V l40,5"5 5/  /  / / / /  /  4af4$$If!vh5*#v*:V l4  6`r0,5*/  / 4f4-$$If!vh5"558#v"#v#v8:V l4D 6`r0,,5"558/  /  / / / / /  4f4-$$If!vh5"558#v"#v#v8:V l4  6`r0,,5"558/  /  / / / / /  4f4j$$If!vh5"558#v"#v#v8:V l4  6`r0,,5"558/  /  / / / /  4f4p$$If!vh5"558#v"#v#v8:V l4 6`r0,,5"558/  /  / / / /  4f4j$$If!vh5"558#v"#v#v8:V l4  6`r0,,5"558/  /  / / / /  4f4p$$If!vh5"558#v"#v#v8:V l4 6`r0,,5"558/  /  / / / /  4f4j$$If!vh5"558#v"#v#v8:V l4  6`r0,,5"558/  /  / / / /  4f4p$$If!vh5"558#v"#v#v8:V l4 6`r0,,5"558/  /  / / / /  4f4j$$If!vh5"558#v"#v#v8:V l4  6`r0,,5"558/  /  / / / /  4f4p$$If!vh5"558#v"#v#v8:V l4 6`r0,,5"558/  /  / / / /  4f4j$$If!vh5"558#v"#v#v8:V l4  6`r0,,5"558/  /  / / / /  4f4p$$If!vh5"558#v"#v#v8:V l4 6`r0,,5"558/  /  / / / /  4f4j$$If!vh5"558#v"#v#v8:V l4  6`r0,,5"558/  /  / / / /  4f4p-$$If!vh5"558#v"#v#v8:V l4  6`r0,,5"558/  /  / / / /  /  4f4$$If!vh5*#v*:V l4 0,5*/  / 4af4#$$If!vh5"55)#v"#v#v):V l4?0,,5"55)/  /  / / / / /  4af4#$$If!vh5"55)#v"#v#v):V l4 0,,5"55)/  /  / / / / /  4af4`$$If!vh5"55)#v"#v#v):V l4 0,,5"55)/  /  / / / /  4af4p$$If!vh5"55)#v"#v#v):V l4 0,,5"55)/  /  / / / /  4af4`$$If!vh5"55)#v"#v#v):V l4 0,,5"55)/  /  / / / /  4af4p$$If!vh5"55)#v"#v#v):V l4 0,,5"55)/  /  / / / /  4af4`$$If!vh5"55)#v"#v#v):V l4 0,,5"55)/  /  / / / /  4af4p$$If!vh5"55)#v"#v#v):V l4 0,,5"55)/  /  / / / /  4af4`$$If!vh5"55)#v"#v#v):V l4 0,,5"55)/  /  / / / /  4af4p$$If!vh5"55)#v"#v#v):V l4 0,,5"55)/  /  / / / /  4af4`$$If!vh5"55)#v"#v#v):V l4 0,,5"55)/  /  / / / /  4af4p$$If!vh5"55)#v"#v#v):V l4 0,,5"55)/  /  / / / /  4af4`$$If!vh5"55)#v"#v#v):V l4 0,,5"55)/  /  / / / /  4af4p$$If!vh5"55)#v"#v#v):V l4 0,,5"55)/  /  / / / /  4af4`$$If!vh5"55)#v"#v#v):V l4 0,,5"55)/  /  / / / /  4af4p#$$If!vh5"55)#v"#v#v):V l4 0,,5"55)/  /  / / / /  /  4af4$$If!vh5*#v*:V s4 6`g0    *,5*44 s4+e4f4$$If!vh55#v#v:V s 6`g0    *,5544 s4+e4$$If!vh55#v#v:V s 6`g0    *5544 s4+e4DyK www.sciences.sdsu.edu/cdiyK Bhttp://www.sciences.sdsu.edu/cdiDyK www.sciences.sdsu.edu/cdiyK Bhttp://www.sciences.sdsu.edu/cdi^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH 8`8 Normal_HmH sH tH J@J  Heading 1$$@&a$CJ(OJQJ^J\@\  Heading 2$&P#$/@&`5OJQJ\^JL@L  Heading 3$$@&]a$ 5CJ\`@`  Heading 4$&`#$/@&b$5CJOJQJ\^JDA`D Default Paragraph FontVi@V  Table Normal :V 44 la (k (No List 4 @4 Footer  !.)@. Page Number4@4 Header  !PB"P Body Textx&`./b$CJaJ6U@16 Hyperlink >*B*phHP@BH Body Text 2x& /b$PK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3ڗP 1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g- eW )6-rCSj id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R3U~7+׸#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Ptheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] \ A\_ A  $z-./0124 5&6&9A"G1j7A|E%IPSVY\`cfinz- [ 8n(X^9f?34DETU@6 Y"$'))L++,^--f..`//\00^11`22^33V44D55J66?8@8<= >>\???@@HARA6B@B^ChCC(D\DDDDE:EEEVFFF*GTGGGvHH I`III.~..4/d000021f111202223F33N444"5\556@6n66B7p778T888&:l;AAzE|E&'()*+,-./0123456789:;<=>?@ABCDEFGHJKLMNOQRTUWXZ[]^_abdeghjklmopqrstuvwxy{|}~ K{!X!Xl ,b$%I4` 5h@(  t  c $|#" `? B S  ? AP*Tu2pv24pw2px2|y2}z2D{2k?k?2@2@Ar?r?9@9@A9*urn:schemas-microsoft-com:office:smarttagsplace9*urn:schemas-microsoft-com:office:smarttagsState=*urn:schemas-microsoft-com:office:smarttags PlaceName=*urn:schemas-microsoft-com:office:smarttags PlaceType s7@CJ NVktL$P$Q$U$((U2]2?????????? ?!?)?8?A??????@`@@@@@@ AA3 5 <-D-11d4k4?????????? ?!?@@A3333333  2 : LLdNNZ23!::??????????? ?!?)?,???????@@@@@ A A AA?????????? ?!???`@@@@Aw^d^k':yjl^`o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.h ^`OJQJo(oh ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(w^d':y         |Nft$A0??@\$')*O/O0O1O2O3O4O5 A`@`,`2`6`p@`>`@`B`D`F`H`.UnknownG*Ax Times New Roman5Symbol3. *Cx ArialA. Arial Narrow?= *Cx Courier New;WingdingsACambria Math"1h:&:&\rFj 5 rj 5 rY4d>> 2QHX ?t$2!xxjChild's Name _______________________________________________________________ Sex _________________________Virginia MarchmanKaren  Oh+'0( 8D d p | lChild's Name _______________________________________________________________ Sex _________________________Virginia MarchmanNormalKaren2Microsoft Office Word@@Y@4ڀ/@4ڀ/j 5՜.+,D՜.+,l hp  KUNIVERSITY OF TEXAS DALLASr > kChild's Name _______________________________________________________________ Sex _________________________ Title`H4T _PID_HLINKS_AdHocReviewCycleID_EmailSubject _AuthorEmail_AuthorEmailDisplayName_ReviewingToolsShownOnceA G!http://www.sciences.sdsu.edu/cdi G!http://www.sciences.sdsu.edu/cdi CDI Word versions/pdfvamarch@utdallas.eduMarchman, Virginia A  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvxyz{|}~Root Entry Fۈ/Data M1Tablew/WordDocumentySummaryInformation(DocumentSummaryInformation8CompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q