FLORIDA DEPARTMENT OF EDUCATION
    Academic Achievement Through Language Acquisition
    Office of The Chancellor, K-12 Public Schools
     
    2005-2006 ELL/LEP STUDENT ALTERNATIVE ASSESSMENT
    PRIMARY DISTRICT CONTACT
    REPORTING FORM
     
     
    Please use this form to report the contact information for the staff person you have
    selected to be the primary contact person for reporting the ELL/LEP Alternative
    Assessment Results.
     
    District Name: ______________________
    Date:________________
     
     
    Name of Primary Contact: ________________________________________________
     
    Mailing Address: ________________________________________________________
     
    ______________________________________________________________________
     
     
    ______________________________________________________________________
     
     
    Email Address: _________________________________________________________
     
    Phone Number: ________________________ Fax Number: __________________
     
     
    Alternate Contact
     
    Name of Alternate Contact: _______________________________________________
     
    Mailing Address: ________________________________________________________
     
    ______________________________________________________________________
     
     
    ______________________________________________________________________
     
     
    Email Address: _________________________________________________________
     
    Phone Number: ________________________ Fax Number: __________________
     
     
    PLEASE RETURN THIS FORM BY MARCH 24, 2006:
    Via email to pat.faircloth@fldoe.org
    - OR -
    By fax to Pat Faircloth at 850-245-0846

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