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Leveled Literacy Intervention Sampler Request
Personal Information
Please pick the level you wish a sampler.
Blue System, Levels C-N (Grade 2)
Green System, Levels A-J (Grade 1)
Orange System, Levels A-C (Kindergarten)
School/Institution/Affiliation
Title
First Name
MI
Last Name
Mailing Address
City
State
Zip Code
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
AE
AA
AE
AE
AE
AP
Adoption Information
What type of Implementation?
School Wide
Disctrict Wide
Not Sure
Have Funds been allocated for this project?
Yes
No
Not Sure
How many Educators would be involved in using this product?
When will the decision be made?
Within 30 Days
Within 30 to 60 Days
Within 60 to 90 Days
Over 90 Days
Not Sure
Contact Information
Phone
Extension
Fax
Email
Best time to call
Morning
Afternoon
Evening
Anytime
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