OMB No. 0607-0987 Approval Expires xx/xx/xxxx

TYPE OF CHANGE COUNTY LEA OF CHANGE OLD NAME NEW NAME OLD GR LOW OLD GR HIGH NEW GR LOW NEW GR HIGH OLD LEVEL NEW LEVEL OLD LEA NEW LEA CONSOLIDATION1 LEA CONSOLIDATION2 LEA CONSOLIDATION3 LEA CONSOLIDATION4 LEA CONSOLIDATION NEW LEA ADDED AREA LEA LOST AREA LEA DELETED LEA NARRATIVE/DESCRIPTION