TITLE:



INTERVENTION INTENTION FORM

SCHOOL: ___________________________________ CONTACT PERSON: ____________________

CONTACT PHONE NUMBER: __________________ CONTACT E-MAIL:_____________________

LOCAL DISTRICT: TRACK:

Please indicate which program materials will be used for intervention:

ALEKS (ALEKS Corporation)

California Math Triumphs (Glencoe/Mc-Graw Hill)

SRA Number Worlds (SRA/McGraw-Hill)

California Fast Forward Math

Odyssey Focus Math: Grades 4-7 (Compass Learning)

Other:

PRINCIPAL’S NAME:

PRINCIPAL’S SIGNATURE:

c: Local District Superintendent

Administrators of Instruction

Middle School Directors

Local District Counseling Coordinators

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SEND THE COMPLETED FORM BY FRIDAY, JANUARY 21, 2011 TO ATTENTION:

Cristy Mercado

FAX: 213-241- 8977

or

EMAIL: cristy.mercado@

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