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* 1. Name of School:

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* 2. School District:

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* 3. Primary Contact (person with whom all communication and arrangements go through):

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* 4. Primary Contact Phone

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* 5. Primary Contact Email address 

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* 6. 3 Team Members and their roles at the school (3 people are required for the activities planned):

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* 7. Describe the top three areas of need for your school around this topic, and why work on a responsive plan will help you overcome these.

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