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MEM-.5841.0 ATTACHMENT D

September 5, 2012

NEW TEACHER SUPPORT PROVIDERS NOT NEEDED AT THE SCHOOL SITE

2012-2013 SCHOOL YEAR

Name of School: Educational Service Center: School Phone Number: School Fax Number:

Principal’s Name:

Signature:

UTLA Representative’s Name:

Signature:

The following teachers have been selected eligible to serve as New Teacher Support Providers for the 2012-

2013 school year, but are not needed at this school site and are willing to accept an assignment within close proximity to the school:

|Name |Employee Number |LAUSD Email Address |

| | | |

| | | |

| | | |

Important Reminder:

Please list only those teachers who met the eligibility criteria and are willing to travel.

Email this form to peggy.presley@ or FAX to (213) 241-5494 Attn: Peggy Taylor Presley

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LOS ANGELES UNIFIED SCHOOL DISTRICT

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