ࡱ>  ! bjbj:: (`PP 8 %@eeee" GIIIIII 2#rIIee4^XeeGGj6R1;dt0## g:    Department of State Health ServicesDSHS Use Only: Reviewed By: Approved Date:Send to: 700 University Blvd MSC. 221Kingsville Texas 78363PHONE (361) 593-2237 email: HYPERLINK "mailto:Randolph.creel@tamuk.edu"Randolph.creel@tamuk.edu HYPERLINK "http://www.dshs.state.tx.us/" http://www.dshs.state.tx.us/ Campus Program for Minors Sexual abuse and child molestation training and examination information Texas Education Code 51.976; 25 Texas Administrative Code 265.401 265.405INSTITUTION OF HIGHER EDUCATION  FORMCHECKBOX  holding the off-site program or  FORMCHECKBOX on the grounds of which the program is held:ADDRESS:ZIP CODE:CITY:COUNTY:COUNTY ID#:PROGRAM OPERATOR if different from above: PHONE:PHYSICAL ADDRESS of location where program will be held, if different from above:ZIP CODE:CITY:COUNTY:COUNTY ID#:DATES OF OPERATION: SUMMER CAMP AGREEMENT BETWEENCAF 9-B Employee NameDate EmployedTraining Course NameCourse Approval #Date Training Completed Program Operator: (signature)Date: Environmental Health Group PSQA Publication Date: 12/13/2011 Publication No. EEH - 28     '67ACDSVWXYZb       sdYht5CJ\aJjht5CJU\aJht0J5CJ\aJ)jhx,ht5CJU\aJjht5CJU\aJht5CJ\aJhwbhht5CJ\aJ ht5\ htCJhtCJaJht5CJaJhQght5CJaJhQghtCJaJjhtCJUht'67DETUVkdn$$Ifl4FLp;*`$  0+    4 laf4 $$Ifa$gdt $$Ifa$gdt $Ifgdt UVWXYZUkd$$Ifl4FLp;* $  0+    4 laf4  $Ifgdt $$Ifa$gdt $Ifgdtulll $Ifgdtkd$$Ifl4FLp;* $  0+    4 laf4  wnnnn $Ifgdtkd$$Ifl4FLp;* $  0+    4 laf4   Q R S wnnnn $IfgdtkdU$$Ifl4FLp;* $  0+    4 laf4 / 1 2 3 O P Q R T n   ( ) 7 8 9 Z [ i j k s ƹ򮦛xlxZlxlxHlx#jhhhtCJUaJ#j,hhhtCJUaJjhtCJUaJhtCJaJhtCJaJhghtCJaJhtCJaJhsjhtCJaJhtCJ$aJ$ht5CJ\aJhnht0JCJaJjht5CJU\aJ#j^hnhtCJUaJht5CJ\aJhQght5CJ\aJS T n  wggg$x<$Ifa$gdtkdG$$Ifl4FLp;* $  0+    4 laf4  `kd$$Ifl(L*+0+4 la$x<$Ifa$gdtpkdl$$IflL*+  0+4 lap  xvkd$$Ifl4(0Ll* x0+4 laf4$x<$Ifa$gdt ueee$<<$Ifa$gdtkdV$$Ifl4(FL l*{ x0+    4 laf4 M W {{$x<$Ifa$gdtskd$$Ifl(0Ll* x0+4 laW X ^ f r xxx$x<$Ifa$gdtvkdĵ$$Ifl4(0Ll* x0+4 laf4r s ue$x<$Ifa$gdtkds$$Ifl4(FL l*{ x0+    4 laf4s         ! ǿjhtUh5NzhtCJaJhtCJaJhtCJaJht hd~XhthtCJaJhS?htCJaJ $$&#$/Ifa$gdtckd8$$Ifl4(L*+0+4 laf4   ||||| $$Ifa$gdtgdtrkdѷ$$IflTF\%)ag!w t 6?*6    44 la       NEEEEE $Ifgdtkd$$IflrL@ H $*  pT t0+644 la ! " # $ % NEEEEE $IfgdtkdS$$IflrL@ H $*  pT t0+644 la% & ' ( ) * + NEEEEE $Ifgdtkd'$$IflrL@ H $*  pT t0+644 la+ , - . / 0 1 NEEEEE $Ifgdtkd$$IflrL@ H $*  pT t0+644 la1 2 3 4 5 6 7 NEEEEE $Ifgdtkdϻ$$IflrL@ H $*  pT t0+644 la7 8 9 : ; < = NEEEEE $Ifgdtkd$$IflrL@ H $*  pT t0+644 la= > ? @ A B C NEEEEE $Ifgdtkdw$$IflrL@ H $*  pT t0+644 laC D E F G H I NEEEEE $IfgdtkdK$$IflrL@ H $*  pT t0+644 laI J K L M N O NEEEEE $Ifgdtkd$$IflrL@ H $*  pT t0+644 laO P Q R S T U NEEEEE $Ifgdtkd$$IflrL@ H $*  pT t0+644 laU V W X Y Z [ NEEEEE $Ifgdtkd$$IflrL@ H $*  pT t0+644 la[ \ ] ^ _ ` a NEEEEE $Ifgdtkd$$IflrL@ H $*  pT t0+644 laa b c d e f g NEEEEE $Ifgdtkdo$$IflrL@ H $*  pT t0+644 lag h i j k l m NEEEEE $IfgdtkdC$$IflrL@ H $*  pT t0+644 lam n o p q r s NEEEEE $Ifgdtkd$$IflrL@ H $*  pT t0+644 las t u v w x y NEEEEE $Ifgdtkd$$IflrL@ H $*  pT t0+644 lay z { | } ~  NEEEEE $Ifgdtkd$$IflrL@ H $*  pT t0+644 la NEEEEE $Ifgdtkd$$IflrL@ H $*  pT t0+644 la NI<<<< <<$Ifgdtgdtkdg$$IflrL@ H $*  pT t0+644 la            ~||||||||z|zgdtL^Lgdtskd;$$Ifl0L*0+64 la    ! gdt&1h:pt/ =!"##$h%nDdHF  C "A SealbԨ &ỵE Dn &ỵE PNG  IHDRƮgAMA|Q pHYs.#.#x?v9IDATx_G2R` \ %Qci%gWnݯ~0iCzl-Xsw0o1a ؀mfMSMO6֫,UCtv*qDdDfD{=̜i7'9q !W/ =F^={u={9so9sxQsx7O 7|j^7 ]^%ij<7+Fu"t<x ޅ߅:1wex,E~QQ&ٿ(oIjb5ɂz.w>R?oܵ'(ر:W ׽8" ^!k,ojlsᕬU+}(6iª<{^XjD7?y=^ݺ'mz>g⦨9×iwρ׳ udM oQ妪u5 h{>57+0|{<~P*s+\>xwSɢԆ4Zi׻5Էn5 J܂xP,YuXv{xlYI~IОGlMլqñ1^M}[QCtW6W-q5@ަ9jmUUnHo"i)i\ntm7*UhoZ6ūo{zL7gd@_mG3k1zo5DKmZ6흇Aۼ5ҽ=KZgסo"^{p>7gG7o+5 f5$7H*?.G/»&·޻ib#rEt |MhŖ`?O (GkϷ ^Wc5JI$U>E {˲s= |fN066+IVƌwBxYԻd ^Ϣ}_jV/E/ƿRU(g}AYѠS ^'_~ ^DOOo#ᗓFWk7HQS4RK>Wǯ'Ƽe+C=!Dz/l(GF$1 KC%5 LjvNk I˱_)ZYiI2*Ӣ'OI27Oʂ𵃃xfd3;rM4ޱV #cc- GKY`k%Qzfm-pMa/ظ$^6e۳4 _Kwj~\ˬd|W;oG/@aޘɕ:xo}+Ti+aRҬeh~<xJ>xZxx3tEF)+;p9SLLab~ 2:4G|./&WV:fm <|O3I'=xa[U 5:bO{6H'wmht;C04 ^k¥5hl 5j=2(wG .Mδ~x /[Cz4ߴ~4;1ӥY5tCZ#Cvoޚh౑5tWh2kd0^7@uxTR1tW-xD'wdSa؀!]kc?[xbtb.Ipy>ӪQ5܄u֯1tW)^X~?#Ɔlk xIq1ei_uHa^]h KO;]'_ ZkФXh³oilہpeâCw%^ 7bojU6;G`cZzQ. ofr ,ף)H ]YV運 WD&; $Et].ڌ;_OWb͡-nՁ5< +U@C+{xHpyiѬ,MaȐv;ӭs(Ҝ+*8 OM-\ACwfY7P&R&xtjKh&xzgV)k1f]9W 2wx]V'alzfrZ߇QVgk{}= \:[CꁫơdOt5SywvqYWjx5 ܞFFK[كƆ2k8t5 .oNY쉮;Xx{ Ͳ=yn f'ϙ */~.0 J`dXY\<_vO\߅nf뜁+/Y쉮sf]asiz,x/bOt5ޟ6bo(e \L|{(zS0),xW򗙭YgމYxS0tWjy<+^Y.Q0t*2&+.^:Z.P=KNA!,+zʓH{kZ'`̰Y<Mjni)޾^?E@H*2oK[^pfk<<ī>:4y`;55)yCIkcJf)dzEHxY&xNY]^~5tQ2xuW9+~kkk{ۛGx7o%R{[X3Ikd_35fH-t>5G[]Ls6/?iBդW!2gkkT[v4;=ɱu_ęëH@l4ߗffS=%k1;:ÿ+YP{5˙O7zN'q*tM>RAkt(MHI[ jۺ&`Ifi`<,.<^zS@'yxYep`&?vPtă^9r.fXK-Z}VNaO%Kfn=dV[q@<\!.=!sf^qWM,D7P9ׯ,TI[8x]7,aj՞"o<~m40-xo59?x㯑f9^iJwG4t?ffM㳾Ok]xZ(f$4t!R㧬7kЭf ^{JA7~=d,moLxD Wne L4,5y*b/zQ3-:59Zr@@8I5r;2xc;"Qm?Od)#QMMA\W8t?fYʝ}lG)MfQ|az+/JZTx:@nׅWn~Vkyb?43/W^v[e_-~k@Jh0Ӏ(s1R}R+0=W>,/Z4,6ì-&*Hb>L$A)p|SZA9b]څrJ6FKݺy8̆2}zQA?>x V ofC:V9%~㗶Pm꪿a5Μ iW^4ۋ}ݣJh0p[sG| =K pt -Q-~Nw )lσGd4L} =+Yc4K]כm H #aA}T[z9j=0q.G%PguĿGuI( =+g;{J)Jzb.2MgwVѥQ|AqV)=pR~m0vg[CacxGw|h^]1c K[r qɬаCvT3T|!<֒?PkDl(Qn<۱fAԙf?1FЍzVXdHk)Zu vŷ1ʬ /0,욓۴a`rO RIG xTeiRnݞTc_P/PW:ԞW(J^4ڢ0U? C(kJJ1+-Z 8mc U?= $@1!xQ88なo[(hXðKQ4ڥe]^bQh }R[!kJQn\ ;):?mLxJѬC;Dmye@Qn\7ëմoh<,%4/y3z1^_/@+ڻ^x7 `37nU0|= kP/@+S6U<|Qviz0Яm6z^V!fIſrP/*4Q`ڃz9ZJgk

r깳/r=8e?^EZY#|A/lcmn;o: Yݓ^d-%%Cy2Λ9&Hi{.QCŁ^&<xfVc,ۧ[ W.=csYvkErhwlLxQ+s!=;tCSv#/guZ+7| h?Ʃv6SςJOS@/og2,lvݪD/ A9fËgr^>t4zY*1 ɞrH;he³AC#=^<2gQPw>nHe/ O2k @ 6 =)K/3{p3grRlxG_7Zz8WUSifgf#W gC4NߚvӪ-̒tr BxX1}ս vAI*#O:AWN:zxNlh(բ2 z;,?2]?̆N ot *+&b|uAS w="rKO\. . ƚxh(.^z4z{-uբjCPl~?7@V͏FnwFv3Q/]q_4 DUUhf#ބa=KɵKәOf><5QQBqNzɠTK;q6)]qHqtwEGF9E8l65)^ R+tC|Y@YY5^? gr'hx! [7d62xlx"Π-|VmG6M98LI ~j|-dlٞstnl3±1M/!65^mZ?wKyK<,iDCUy:&Mk zަol3Ƒ Y`F6qw¹)yF lWY%(p;K\H32_j<iJʜ/s9l\ӡxXgڮƫq99zaZyjW2<-p3tQ5#sag* M#ck ܭxٹxmm)ѝ<bݗ.~^.i#Y"-<č;o̰IXC%n\xJ[x`>]WaoQI+4Y.d MH)X_ߘyXf9D65c<49`w/n\0AxhtW,2ّ]&wNqƃ6 ICJFwd$:Y:d<>Kk/)}Az$3 rB&|:Ooj+%1k}(dNb%lŪ'Vh]*u9c@zډ,V[gGl^7 Fx#}qG=L~Wh妚Ǻ}'Gݛ~o'ߐYP"OGx^y׎ Ԟe!rL }Yk'GA^)wX۲n=?UnO=x=:п^gWj0'{оZ iG=@W)EUȣ};<lYl25o~ ݉O0S6ozt;ìM %4%̵ʱ;< -uè͞p--7^U|n4uQFj8 jp3㬚 B3O O OGtF5)7jH*x%S ӿ*C_i=dRݙN`U=[[> B8+mT^.^ލ 'n-'}BF< )bGjרz* OpM7^W^/u.Zgg AfzOD;Hٷ5'pg<CThÐC\s<mCgc@q&-rk^^p^@JP{t_V =!_Z\8qzeqz^ 3yF$,3pok _QmmhBy2+8!S=Ȗ/TzPY3(^B'`8,0Gqm&+ÈXQw:쬃H|܎'ciД d3ZD;֍Uk-te(Ba 4p)GxC@9G嶭?D2d>;"ܥľ(FÉjD[Stj# +Wwb4 gdt=v9xTAdzQvʩ%u]uK&b]^(L-NrcTSTNbw !HK\ϖXv<񴦂?Kygջ_J0.sVfLUC?ݵqjffV 2[ɓ21&Mʿg1*==C7TTn'xjtnr]צ>!*W?ƀL\ \ƝjH;ZK4TyPZ}qAo}}aECazg5=mQTK,<-e}7)Ԕ؛.L1FrGTuHN. ^;_ AVk<=̪m )x ov rGdxN80Ι:ڐ/\pP6d6v'[{:3'_v74S i5pY>OL2c4D,^vtѣo Tg 79xw W522w#.Nxo!kg6$,ǣR{T! <7ʯv2x9>[ q/ 8tpޔmBG] oYڬ+!cCW[+BxS$9(u^<7'^OeLnRO}t } [AVGjv4}t≻> ij3HImHHs*(P +Q#$|G08Ὦ~+pRf.P^7Ayc;jZOP16Σ6Gx,{q9(}:{0`b9 ᥀guM+.-Xn,֌7t|>\i6IhJjZכm:??tKխ { Uz. [Cr.{ЗFM?@6fLƙaygʃUr0z7tR \kljz<}ܮ[`D΋sBst}x8ء_PJ\|AUꓘq2)헶ryYƓ"#^P{D[р>J6f(bݑ*߂ )חǗ"!-è{ R xӚwkultltxgxȲVp?wKGJ,68~=ySU٨͆VWNBǛ𼾼$KIk( F=o~i}]e/}xd~tK`@ɜu<+rک!q/2x4m)H}>xd9H»x].InKIY^W>mFCxD{Ialv?aN:~Ŷj; k{`s ʥh}6#E@).61,_3]'ru7 ~k,BI$GY2{6 L,q#ET陮5uMn/^& Q`7/EO ~HxԷx7+P+x,eO@(6ekV |est1\7SUU+*$Cs|6m$TCS7ꮖ3NBZY]O+vϣt9.fZq[- M5<]TD~s+} |Bpt [\ؓ k;Xb҈? :nIw^F/e,$@" Ul|lH>em\ݷU\.[G)mkYwa [oa3X K<'C̃x  y®qYLB ?^p@e :Ԋ*B-QDOx0hEP6;r||lma-ky Eݠ 'ృzj)ӜczV"#aem[<ŋ3=SK-Gxlf1#c[;w8L6\-!"{xʰlON#[Skr4Uxy.;,^|W!b'G2|C, V t^x۸ ԁ2||rt9#憌jă ƻτazq\㾏KW~f2 0wK!Yx51^p]}gXW^g~.Gx JZM Lr%^*2ogCmobj&7۲/! YyN r L޷2Sh% _I'1^2x8U摠`b+^ ޟ{O,L~ŝIKxI>{ x[f]AMs[y/̈́]:{Cܻٟ͟lX+OaT cv_dOs9r# ͛{츿;\5݂!ո>1n1xM̹<mtzSD<~{)|7DM'}cz_US$ W9gh"n`8lOVΗ8K슥3xivSI)| ?w8,ȃ hӲG:5ʲcg;9x u?ɟxwc[+ZA"1KLjjq &c<<)X҃ɳJU㡰<1xos*o<+}x_X* []3;~ >$%9xx;^ |xݗF+;ax{9284DJ]v'kh7EӛL]_q˽x$8- E?քkT^x_@SK [pOYI:y*t?IO7j IG!nI Nsk. y`LK`=t^qD,-vO&mє%6Kq h[ ȕ 0027r9LV;;uT9 ྨV,xT8p_(b?:M QZ8hCMdV)!&^Qq^ONL{4C^MI4R:p1^)YZz[tAxm&a >*Ųǃ+-;ե><>zM o2+JKڝ6SuxK_PrmWsT hs>ӧNHkkmL@{际dAw381'>Ǔ }FJ=df/&*)F FfQ'PQngrxp%C'O7)Lzj:-IdxO4Es:̚S~Bx{zR5M҉h=.h鍰ۧVl> q1%Ճ:V/S KW*Wrv}x5Zsy?i.Qredeq4 0)mV=$w|&t=o&٪|9vN@Ɏ"}֔Bt.٫Ex<^ţG2I `Y[09e~x i`] S1{2-s+W9?;օ4Wk?Юƃe 4yoţ2/{E,ŰR ƣۖۍx!P oQe2b՝erL6a]h mboJa-tW9 ulϰr;xM["JͽCx^<:&JnKӢRo= 7unbrxmRHxVxj0cS}&oix( 71##C}ówRu{ƒn_><6J~I錧'A7q݅`^Wy  ͇1^]Bt0YK[:l=]/vN-xp_nwbzXz; \t෥_l*&T܏7(;O[1K20|feJ+޾O-J Z9nEdW⡓a3ʌ%e tj=i Z^0Įx{AcY=ҭgG5~x-C[g3UM'frMĈ;x8r> ]+U xk9Ѳ0{) HVvR/jJ1 hm9x,2^&ZӗҘ{nȃqoxRbx@Qᑦ =f'7 0AIcr,asKgmŔ)Zxl.28oސݜhădt4e=@4F Nւkn~D? 'ۗmtc[.?'=Ai5”/hr6 $ρ1^|(w*c1Ow! Nm&P+lWO NO%-u Q/ǑU[M3Hv/ ;=xTGxv|x.׉Ƌ;oSwS%~^fmq\GkޞO#Cs%+"ܪ7,^W-M8Z~6߷*Ϟ>`94^UsEGAe d*k_G^Axz_s!3#F_m^wPuQ5fq'WXC^j6ow;r aV5{hZJVP s#ƎBo \1 YWƎxj/TŸeX Z͡N[:m<=nD=4oҰ`ǷΧՇC)8ڊ<ݹk}9oZ|zs['Gj3W^yƓ:,QQ^޲sfꢋj]jH*DzCaeYR(Gri걵Z O@xgJq]ѭ2w*dHt3']<#$f pãhp/xmlky߳p6/s!}+nՕo>h18AwF`d#+jPu nmLׄ«1Կ´[1lF;U&~:)} FͰ.n+(4|t瞌͘{%N]*qL|_?kᮛIJAIwDq"9T,ݍO4ƫ2_^Feo7ã KGxjNpG:B{1^2.xnʆx  M&EGVO˧L5׼qsʦoDRx]E9oxf߀{?' 0 9 h^4` ƲWb5Uhk^r2; }zQ,<{σ'O=;8]xkaM"cvlh\  or P˼K* cU;}Im]=}ebJ4Z6ŃD }jM:6NƵ)(n~8G9L5b D8yr6 WMȘ V "zl_Cx*<|V2(# IJ1(Uҕ`lj"p6FكNrNx8ɐdPֱxC)>f&6;{Zx}B3NRqyq({$(b}6;䍘'+N$-fk͍2( vHъf>!6Ζy<#=5v ᕀՖ#>7C[+̇|2緡8݃KU޿3ٰՓ<ʻ$Lzy<-n1?)%Sx;P6όjS_&mk@fVRreԛO ?A:AK ?};8XzTf4C5 .x_pYtW<(Ʃ&;B?,XXq{ؠdeq/<٪uOy eg. d15-5›ǢJHDeo${f܄w~XkˀWPDW 3 z+3kŋo O4{yz "sh +UX̏`ר/*? }S5SSeQ]ivem1תsxN)/іNXuFh:v.(q:XSF/mq~ODe(#d;߆tL'g WK{tfyxMf }aţLTDo)%Fwݚ t8~=S o !^Ԣπ{9;$ ]yz£grwE#naR:g c-\˰ۣxJz%!@ἡ>,+4նx#*HX<_$ <ϡ>{̇7ۨ4gic7,GӔղ5.lU~<}~Q<nlghӪԠ`U,8tjn&Zε.:,-lKVy ϲj9ڴaKS۽)'5y*Ǧ}aQ/*TSh3b#dLW~kBݫtݐjԿ?DO}l 8x0x4 w#ViÆB<^w`0 Ji˿nW`'?ͦxYx(GԈ?iNOfqj}\ыqЦ!^Ftyf!X^f!`oH0/.xG`6N&xp,wF^Q{sTGKG੧U5pSs;]{sK^^5Sd3{ٙKgwJs? @.#VT3{>P5hfS T1<|rV0r޵;K'\'|g9xG`mbxV,SW CLqWTk퍂&Gۓn.G]V#V9,o xKZ x1 +x`ڔɀ] ';98zt4mDaܒ#5%aח߂%!g!IclcΫoZ_~)Gǫ,,%|vx{3w *\Bskg}W8;tXx5w!`JS+o[]@*%F%Hݽ[:WYx}"3c-\jۙRɳqǓuj,-{Bk [;.ǽиz01O#&𳾷'ۚ?<@̝?61 |5p\ QIkWge֚}U"c56^Gx5Q;xIjIrtrV OS^DO0^H-C-f|AkVc<_B{!u$A8 X'/_ymwbjK4^/pR/kLRg5UB<0‹ojhB' ~\xzY3SxzG/}@ؚUcu.`#Mϛ;~2 ~\s]S&7 z!̀>dǵ6/*$0B+X-Z<<]i ATC(jW~As(jG^.%^>œ?FGxKڂzb;T$Ǽ3s3'{> j^^xaDO ^1;N5hsST*ЄJj<\0AA?i+diLz -Z ̏ha}TgQZ?; ^<5:3C/ϬIuɋt8V9c-W:\%IAk(M5&x ³2G{*>/XwO}xeI ^[f>,JE93%7;ǰ=~߳U(־2Ӳ:*0=<\BLR8w,x_ʜD9^%SrWr?^xNFBDOj3uGiDJE Io2+ha;R& t07Ʃ" |tHj\'47?tCf<>Zor9+f dB ,A$CvUv)oE=Gݫ5ސߴg+؛Ϭz# 33'{S|u'O2^oXGxʦx02+5חg޸tjAj]E-G 3PyP xfhJd^NxWxw"ot~ Oǀvx!Ba6a>~9a.{f8\%X ^ngVuIfG,1k6Grm|/0x:CN4s0: r2s-xT9!O]޳~p5j= ^~YOej7_//{M rW,h2xV\% ƃ%q_Y>no\!E}4׻g$|-dExҚFK$4ƒ]`q%rz`o>8Wx j#7CN%/a-o8ؿC.9!iA ~E sQj#셩'1s0lR1fTw9"xoT~% EZI R n?/o*3JudrO}<eoǷ$$e&?MixAZaTrь6Y 谍 CmE 5)aL_p> x3Զ!mox8Հ!vAr6=}J:Aae^`&9>ݕU;Z.;K :{w1%` 8 Nye&_]."'H$m~We\?n<1D1(u_U)=tl<g^ڌzi8b!܂ H-I9&wWqQG8y+'x O:,SruRu3֖viU쑻JΰG`Qy܏kT |({{f5ҷxW`gx01]++LZ_*@rP'j b^EK!?%i̜Io@/Ķɛp/d@6# cYt^-pxIuWh s+]p3&3jzI ˘SC7͋U'^KnCJ;c?^lMsm4aT⡐c\4O_ݕ-8u,Hhiqn@xM]?1Yu9x.9bȖ=LrGׂO~K@wQ^ 3ޏ_pbCP)<j ?^!LZ]^ zkrA1^햵~ 3tr=~qB4qCxXff!6fYSi{Ξ xz&k<^])| >&1 =/&4^cwXxj5Z#0PoQP /ʐD}.w=[xл 5 Qs B1cޡUG{kOԬ\OᬭP ,@d9̆OD5iˏd|WaͣvI5/l|Jҿ0U鎠]ɷƙ Yxd68Eĉt4#$~CA?)<9:e*B>#XS n*ʄ׸xBI ˟ xJc!(μSÓ>emM6xP?xlXA#bD 67hiY ޼WʈAo{&z)3 _'N4~jXx8-ݧB@ǏYI!04*ܣ0T<{pZn3*1\`7*;We5CbUѷ;p T-<1~NSv ]yfJU;a4[eW' c~Z2tYkvNM'VCpʑuOPM<w&y4x?#ģz:~I,QXyg HN2d!{TɆw0~ײ!Nu %E[(Aۭ.Vx = 2lSbG@S ?ߛ>Ԙ$鮫Uݺ߶ij,&4˖bx䀇JKqgfCt $pGH> {Wc~div`7孢G=;l_S?x meK0*((YvF dRk ^ xË,ypweߵ0!0ͼ{\b#]P6QbAoYej܉6)asH "s̓Z'mYβGX 4US?t7||Ce1#cؖ~Z3x^ORxSe٩@.eGq R krV}.7C:!ī .ܒTQZoőN6ʢ *l/m`,[ »^?Y Us^0rm< ~{ p*XYg7Q+({x{1Hy'4a? [ucd[a@]t"f^"pG2=nxiwpŎ/c߫'_ `^^= xDݫ?⑻Kç--  rfڃK}#Sl'Z'pIloqXk^}&_}U}\nj t] :|-OO5^*鼫qo!]!k[?֊Ovfsf>.<:d<͏uô.e0+o% дݎz8([`!n4rA f 6?}{j+r9x3j 0Q6eᗷѣ_0ףB=JZ.~ ͡<-LфW:⣟s{jvzU#w#}qQVfk/K3vx/X;d;F))SߎrTܷrv5ҞWNEӿJrI\w#^`(E8dljj]dObBxK!<"xO'V {{Z2w#/}߸1 ]GZ7m_$<U υ ^УByɉ*a |MxI^^Rjs xT82Nc!eSBSvqf3 (d4ȟ zTR=/0I6o}mGEZYuܖxQ]zR2O!,W0!嶌+H6#]P+?5][eƣ5/lWXOc4ᎻGuYP#v_~Gd9*"Ajߋڧv ὀvj8i?xTtӂ(QX/rMnJO ^V p_C#/ wE go&#-d**5 1·N$>wM{UɈ;Rr7xAeKc/YOrE+E ڛ:,#9G@}XlxӇ^kaY D>E}:5M/ULgⰌekuay@גxs!DN3s d:ySb?G.'@OAC furn>1M5uX&x( 9zpFR)H+XHH)~g=xۅVXNWMzqƵu@g, S]؊Q/9#st]OBO H޻Ti{|̫:\J2Ńem@*a;<\菔{%AFxn>NQ4CW΋7o?6682˂.K7^= {ocs%!e.K'@qmtH3$zmu{&ۯƒn F))vGh-<#(sU:x_}9ѢM}w،e o>1tHIBZmjO 2ƛ PiL<>T2hz2Xes 4멱?rm^QR5x}[!@.5ׅE B Gٵ5B𡐫xŀ_x̓zLn|PIK+F.HGλi{Nhpأk|N=12 usrB!8#f uw|r t`e < NJui5Pf 6#a#T%d~Vط1T'P:҇"W0Tf(5A`".d(w9eq_>=4f(* *f4 ^XJX9׸k<K.zS=ǀ5˦3< V4 uΠ\;X#w<א^Q2ތ%ѦZrqz)c`a `t6ktXw!|{v/^>f!&c3lLC] VQ˕o<krxdtCVݣK+9j;uTOd!lZҮSoЧ$IQ ɩl_I nͥ $GB۴dz. ]^ |*}$O['_!k[5<6ΰ^2 YgghrO'x{fZgv{of#"KC5SZb=6xuWdӯKP[.{ LvӯЏw0Y#<N{LSyFBgRf 4f+t[i^FCNUR-tz86O$.>r<2A-Z;kT"|]StxLoU?JǸEMM4oΪæ'Rw> "zWYa4NM%oKi'xy0nE# `|&׃GV-h6F8 ~*o"+4/ެUQ _C<8plpŦ!'-g8=lhxl/iA_W$ 4ϦBK t 6kU3ԯ-Bx&XFrIFc|xsfנc63 ~ycx&x/lȮ;932fC _51Иǡ;{ެE>:1:4vBMi|l3KR4563#ǦyI&]b%@>doXlKdH ._ Gd~<6a-HR5ʯ]iA 4=ER"Cqϝލ^rzpYa6bu(GgZB)_I2k6DhP zmknl45Jme팖x{Ƭ^5 5z8Nx=8PƜ^fUXGPBo,goFFc}<0szY;"Ծ 5zYFGcܑ\a qL/E9&V"0*ke5ՓV -L dbz0i=hGWzQ7 ?[ݬVle=ŜT鴙&U2Ɯ^6 RY+YQ >k4xd6Ve.0b{M?^Z/˕΋Q@+Ve39ԳZ96(׼^6>|F^NzYULsrhѬ,. mvLkAcOZҾLJ-_uH%o3M9\v%} jr`nd;!iV[<խ7O:%֑<nW[Y}z4z{Y]AS]}j/IASݡW :rHP|p6 )>Rٵ8DǷ⃫79ò+W豫L=CɪKߚ`ф6jӰ՞i&~:/TڰڳԺ]Z@Yn&8UR^U{x kg5t_S{xwIg^"2fgY+3vr5,縴^Iχ/?CEJvN WUx;?tq+*<,`/BXWV=X]>ް <,s^$ѫVХ++Y ]Yj]u^x7 xgj=tUxoE=RZ]ʹ^C7} ouYC,fk2jM/'G+p ♡[\&r)Wxrdž+^z%! K5k{cW[g>.Ӭ]V`*tcjyR0p覗;[)̹ƒVwͦ 5j86@d^% k 5p| ](YFj<<:PvYx02b\A76:w<*\ j:K `͸c_cஃjvYcGFޭ&H]I^Hu2!h˙oz9{X}5.\+Aw%7%|11XC(1uiKC1v)N tC&-$JPp:]ˤWCGH/L=:O^ c3:JV`l\bnXUظ $/hls ^F:o^ƅC 5uQa]T32ֺzx-xeQ^Lںxh.jd4knYnN b^ޣNH/ ٻW{@7p urarݑ.^5x)vxX uօ+5ڻw^NAaCWk.$|TtGcGG;:E.1>E#~Z_O#cF _s׷eFJrX>GUO痌WbF;]Chlcd *˸X#Ŝɕ~O^ᱲ _u>ұImלO4,z#c_w>Ղ#DoXxtWҗeJ::T(|yzl+7( A~ V@;j8oI]]:sM ,+7]J7czԧwk+$|BSqe<8<6mѧjgn><Ƣ1^{7#}ahS<̘ͧ ʍEo],\g`ogאEз梷99mEtOI3.:172PНYUG樴q7)tǘs)&ɬ}x=ېf3QX,*C]syjq3f#t0tPC n2du}'/mrb1;*K=ŽDQvK0켬<%񲋌\A xߔ9sx}x={={97z9sxߨ9sxƤ>IENDB`$$If!vh5$ 55 #v$ #v#v :V l40+++,5$ 55 / / / / / / 4af4$$If!vh5$ 55 #v$ #v#v :V l40+++,5$ 55 / / / / / 4af4 $$If!vh5$ 55 #v$ #v#v :V l40+++,5$ 55 / / / / / 4af4$$If!vh5$ 55 #v$ #v#v :V l40+++,5$ 55 / / / / / 4af4DyK yK @mailto:Randolph.creel@tamuk.edu$$If!vh5$ 55 #v$ #v#v :V l40+++,5$ 55 / / / / / 4af4DyK http://www.dshs.state.tx.us/yK :http://www.dshs.state.tx.us/#$$If!vh5$ 55 #v$ #v#v :V l40+++,5$ 55 /  / / /  / / / 4af4$$If!vh5+#v+:V l  0+5+/ / 4ap tDeCheck1tDeCheck2$$If!vh5+#v+:V l(0+5+/ 4a$$If!vh5 5x#v #vx:V l4(0+5 5x/ 4af4$$If!vh5{5 5x#v{#v #vx:V l4(0+5{5 5x/ 4af4$$If!vh5 5x#v #vx:V l(0+5 5x/ 4a$$If!vh5 5x#v #vx:V l4(0+5 5x/ 4af4$$If!vh5{5 5x#v{#v #vx:V l4(0+5{5 5x/ 4af4$$If!vh5+#v+:V l4(0+5+/ 4af4$$If!vh5a5g!5w#va#vg!#vw:V lT t 6?*6,5a5g!5w/ / $$If!vh5 55 5p5T#v #v#v #vp#vT:V l t0+65 55 5p5Ta$$If!vh5 55 5p5T#v #v#v #vp#vT:V l t0+65 55 5p5Ta$$If!vh5 55 5p5T#v #v#v #vp#vT:V l t0+65 55 5p5Ta$$If!vh5 55 5p5T#v #v#v #vp#vT:V l t0+65 55 5p5Ta$$If!vh5 55 5p5T#v #v#v #vp#vT:V l t0+65 55 5p5Ta$$If!vh5 55 5p5T#v #v#v #vp#vT:V l t0+65 55 5p5Ta$$If!vh5 55 5p5T#v #v#v #vp#vT:V l t0+65 55 5p5Ta$$If!vh5 55 5p5T#v #v#v #vp#vT:V l t0+65 55 5p5Ta$$If!vh5 55 5p5T#v #v#v #vp#vT:V l t0+65 55 5p5Ta$$If!vh5 55 5p5T#v #v#v #vp#vT:V l t0+65 55 5p5Ta$$If!vh5 55 5p5T#v #v#v #vp#vT:V l t0+65 55 5p5Ta$$If!vh5 55 5p5T#v #v#v #vp#vT:V l t0+65 55 5p5Ta$$If!vh5 55 5p5T#v #v#v #vp#vT:V l t0+65 55 5p5Ta$$If!vh5 55 5p5T#v #v#v #vp#vT:V l t0+65 55 5p5Ta$$If!vh5 55 5p5T#v #v#v #vp#vT:V l t0+65 55 5p5Ta$$If!vh5 55 5p5T#v #v#v #vp#vT:V l t0+65 55 5p5Ta$$If!vh5 55 5p5T#v #v#v #vp#vT:V l t0+65 55 5p5Ta$$If!vh5 55 5p5T#v #v#v #vp#vT:V l t0+65 55 5p5Ta$$If!vh5 55 5p5T#v #v#v #vp#vT:V l t0+65 55 5p5Ta$$If!vh55#v#v:V l0+655/ 4a2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~8XV~_HmH nH sH tH @`@  NormalCJ_HaJmH sH tH DA D Default Paragraph FontRi@R  Table Normal4 l4a (k (No List 6U`6 Hyperlink >*B*ph4@4 d PHeader  !4 4 d PFooter  !H"H ~{I Balloon TextCJOJQJ^JaJZY2Z ~{I Document Map-D M CJOJQJ^JaJ6>@B6 ,BTitle$a$ 5CJ\PJ@RP @zSubtitle$ P X a$5\jcj S? Table Grid7:V0PK![Content_Types].xmlj0 u$Nwc$ans@8JbVKS(.Y$8MVgLYS]"(U֎_o[gv; f>KH|;\XV!]օ Oȥsh]Hg3߶PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!\theme/theme/theme1.xmlYOoE#F{o'NDuر i-q;N3' G$$DAč*iEP~wq4;{o?g^;N:$BR64Mvsi-@R4Œ mUb V*XX! cyg$w.Q "@oWL8*Bycjđ0蠦r,[LC9VbX*x_yuoBL͐u_. DKfN1엓:+ۥ~`jn[Zp֖zg,tV@bW/Oټl6Ws[R?S֒7 _כ[֪7 _w]ŌShN'^Bxk_[dC]zOլ\K=.:@MgdCf/o\ycB95B24S CEL|gO'sקo>W=n#p̰ZN|ӪV:8z1f؃k;ڇcp7#z8]Y / \{t\}}spķ=ʠoRVL3N(B<|ݥuK>P.EMLhɦM .co;əmr"*0#̡=6Kր0i1;$P0!YݩjbiXJB5IgAФ޲a6{P g֢)҉-Ìq8RmcWyXg/u]6Q_Ê5H Z2PU]Ǽ"GGFbCSOD%,p 6ޚwq̲R_gJS֣9)嗛(:/ak;6j11太x~<:ɮ>O&kNa4dht\?J&l O٠NRpwhpse)tp)af] 27n}mk]\S,+a2g^Az )˙>E G鿰L7)'PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$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-!\theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] ! `  s ! U S  W r   % + 1 7 = C I O U [ a g m s y   !  !"#$%&'()*+,-./2O(8Zj!XXG G @  @H 0(  0(  B S  ?Check1Check2)["9k"  "  ":t'TUVWXYZRSTMWX^frs !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~ " ^@!@UnknownGTimes New Roman5Symbol3 Arial5& *[`)Tahoma"1h"""!#4d=2qHX ? 2!xxCPMFormKitchen Adrienne james pollock Oh+'0  8 D P \hpx'CPMFormKitchen Adrienne Normal.dotmjames pollock2Microsoft Macintosh Word@F#@8_Q1@5R1@5R1 ՜.+,D՜.+,4 hp|  ' CPMForm Titlepv~     *2>JV^f _PID_HLINKS_TentativeReviewCycleID_ReviewCycleID_NewReviewCycle_EmailEntryID_EmailStoreID0_EmailStoreID1 EktContentLanguage EktQuickLink EktContentType EktContentSubType EktFolderName EktCmsPathEktExpiryTypeEktDateCreatedEktDateModifiedEktTaxCategory EktCmsSizeEktSearchableEktEDescription'A(http://www.dshs.state.tx.us/CF mailto:Randolph.creel@tamuk.edu SealuQuQ0000000048D0FC725F744B4498EEC2D35AA144AC07009D016E7E7930A347AE098135FEFCE8430000016D1E5700006E2D6ADF2EBC7148A574150EBB48DAE30021E04B7A9900000000000038A1BB1005E5101AA1BB08002B2A56C20000454D534D44422E444C4C00000000000000001B55FA20AA6611CD9BC800AA002FC45A0C000000584D424D49473033002F6F3D54584E45542F6F753D45786368616E67652041646D696E6973747261746976652047726F7570202846594449424F484632335350444C542H92F636E3D526563697069656E74732F636E3D41647269656E6E652E4B69746368656E00 $DownloadAsset.aspx?id=8589961818e@a*@p@D*~<p> Department of State Health Services DSHS Use Only: Reviewed By: Approved Date: Send to: P.O. Box 149347, M.C. 1987-PHS Austin, Texas 78714-9347 PHONE (512) 834-6788 FAX (512) 834-6707 email: PHSCPS@dshs.state.tx.us ht  !"#$%&'()*+,-./023456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root Entry F/k6R1Data 11Table#WordDocument(`SummaryInformation(DocumentSummaryInformation8CompObj`ObjectPool?/k6R1?/k6R1 F Microsoft Word 97-2004 DocumentNB6WWord.Document.8