Dale Hickam Excellent Teaching Program

District Contacts Meeting

 

RSVP Form

 

District Contact Information

 

Name:__________________________________________________________________

 

School District:__________________________________________________________

 

Title:___________________________________________________________________

 

Address:________________________________________________________________

 

City:______________________________________ Zip Code:_______________

 

Phone Number:(_______)__________________________________________________

 

Fax Number:(_______)____________________________________________________

 

Email Address:__________________________________________________________

 

 

  

I will attend the meeting in Tallahassee on November 15

th

 

  

  

I will attend the meeting in Orlando on November 16

th

 

  

I will not attend either meeting

 

  

I will stay overnight

  

I will not stay overnight

 

 

List of staff members that will attend: (please print neatly)

 

_______________________________________

 

_______________________________________

 

_______________________________________

 

_______________________________________

 

_______________________________________

 

 

Please email form to Amy Combs at Amy.Combs@fldoe.org or fax to 850-245-0435