John L. Winn Commissioner of Education F. PHILIP HANDY, Chairman T. WILLARD FAIR, Vice Chairman Members DONNA G. CALLAWAY JULIA L. JOHNSON ROBERTO MARTÍNEZ PHOEBE RAULERSON LINDA K. TAYLOR CONTACT PERSON Name: Mary Jo Butler Samantha Love Phone: (850) 245-0426 Suncom: 205-0426 Email: maryjo.butler@fldoe.org samantha.love@fldoe.org K12: ? 2005-176 MEMORANDUM To:? I __[parent’s name]___give my consent for ____[child’s name]____ to take the ABC Survey of At-Risk Behaviors on or about October 15, 2003. _________________________ Parent’s signature Please return this form no later than __[insert date]__ to the following school official: [Provide name and mailing address.] Model Notification of ...
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