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1	ATTACHMENT B Florida Pre-College Entrance Examination Program Selection Form
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3	DIRECTIONS: Please indicate your district's choice for the pre-college entrance examination. You may select either the PSAT (The College Board) or PLAN (ACT). Each school district should complete this form and return it by July 30, 2010, to Kira Sullivan at the Bureau of K-12 Assessment via e-mail at Kira.Sullivan@fldoe.org, or fax (850) 245-0781.
4	DISTRICT: (double click to enter your information)
5	CONTACT PERSON: (double click to enter your information)
6	TELEPHONE NUMBER / E-MAIL ADDRESS: (double click to enter your information)
7	Mark your district’s selection for the pre-college entrance examination to be administered:
8							PSAT (The College Board)
9							PLAN (ACT)
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11	Please fill out the form below to project participation in the selected pre-college entrance examination.
12	District Name	District Number	School Name	School Number	CEEB Code	2010 Grade 10 Projected Enrollment	Estimated Number of Grade 10 Students Participating in PSAT or PLAN
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22	TOTAL:					0	0
23	*Please add rows to adjust for number of schools
24	PLEASE NOTE: This is not the actual order form, but rather a form that provides an estimate to be used by the Department for procurement purposes. EACH SCHOOL MUST SUBMIT AN ORDER TO THE SELECTED CONTRACTOR TO RECEIVE TEST MATERIALS.