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ISI's Focus
on Remediation Pilot
Application for Demonstration Pilot
Deadline: This is an open entry program (but don't delay!)
Print and fax this form to: 201-343-8883, or
Print and mail this form to: Instructional Systems Inc., 411 Hackensack Ave., Hackensack,
NJ 07601
If you have
trouble printing this, click here for a different version.
| Faculty member's name: |
Title: |
Phone: (
) Fax: (
) |
| Name of College: |
Department: |
E-mail address: |
| College
address: |
| Enter the number of students
receiving remediation in the following subject areas: |
Mathematics:
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Reading: |
| For each subject area, identify
the number of students who have difficulty getting to remedial courses held on campus: |
Mathematics:
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Reading: |
| If selected for this PILOT, when
would you be ready to begin? |
How many students
will you have participating in this pilot? |
| Approved by College
President: Print name:
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Approved by
Department Chairperson: Print name: |
| Signature:
Date: |
Signature:
Date: |
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