Letter of Intent to Continue to Provide Instruction - Minnesota ...

Revised July 2012Instructor Contact Information (Note: A family move to a different district requires a new Full Report.)Phone NumberFull Legal Name (Last, First,Street Address (including area E-mail AddressMiddle)code)Primary InstructorSecondary Instructor (if any)Student(s) No Longer Being InstructedFull Legal Name (Last, First,Middle)Date of Birth(mm/dd/yyyy)Full Legal Name (Last, First,Middle)Date of Birth(mm/dd/yyyy)New Student(s) (Attach immunization records or notarized conscientious objection statement.)GradeFull Legal Name (Last, First Date of BirthLevel Street AddressMiddle)(mm/dd/yyyy)(optional)2

Revised July 2012Proposed Testing Plan for New Students and Proposed Revisions for Existing Students. Superintendentmust mutually agree. Tests are available from University of Minnesota Statewide Testing Program, (612)626-1803.Full Name andLevel ofNationallyNormedAchievementTestIowa Test ofBasic Skills,Grades K-2(ITBS)Iowa Tests ofBasic Skills,Grades 3-8(ITBS)Iowa Tests ofEducationalDevelopment,Grades 9-12(ITED)StanfordAchievementTest, Grades K-2(SAT)StanfordAchievementTest, Grades 3-8(SAT)StanfordAchievementTest, Grades 9-12(SAT)Other:To Be Administeredto the FollowingStudents in IndicatedSchool Year (s):Example: AndreaWhitefield, ITBS grade 6for 2011-12; MortonWhitefield, ITBS grade 7for 2011-12, grade 8 for2012-13.Name of TestAdministratorTestLocationDISTRICT USESuperintendentAgrees to thisplan for studentsin years specifiedDISTRICTUSESuperintendentDOES NOTAGREE:contactinstructorimmediately3