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SpringBoard Essential Information

 

Please complete the following form to best support the implementation of SpringBoard in your school/district.

 

District Name____________________________________________________________

 

Address1:      ____________________________________________________________

 

Address2:      ____________________________________________________________

 

City & State: ____________________________________________________________

 

Zip Code:      ____________________________________________________________

 

Phone:  (____)___________________________________________________________

 

 

 

Superintendent:  _____________________

 

Phone Number:  _____________________

 

Email:  ____________________________

 

Contact Person:______________

 

Title:  _____________________________

 

Phone Number:  _____________________

 

Email:_____________________________

 

Please mark clearly which apply to your school/district:

School Level Participation

1.  Name of High School (grades 9-12) will participate in SpringBoard?_____________

 

2.  How many Middle Schools (grades 6-8) will participate in SpringBoard?__________

 

Teacher level participation (Please include special education in these categories as well)

 

Middle School

 

# of English Teachers ____

 

# of Math Teachers ______

 

High School

 

# of English Teachers ____

 

# of Math Teachers ______

 

Projected Student Enrollment Participating in Springboard in 2005-2006:

 

Middle School______________________

 

High School________________________

 

Central Training dates this summer will be provided by the Maine Department of Education

 

Please send completed forms by fax or email to Wanda Monthey at 624-6821 or wanda.monthey@maine.gov by March 21st, 2005.

Thank you.