2017-18 Access ASSET Program Application

District/Education Organization Information

A PDF of the application questions can be found at www.assetinc.org (Resources > Access ASSET Program).

You will not be able to save your application and complete it at a later date. For your benefit, we recommend that you review the PDF of the application questions and fill out your answers in a Word document prior to completing the online application.

Please answer the following questions at a district or organization level.

If a question does not apply to your district or organization, please indicate N/A.

Question Title

* 1. Please indicate your organization type.

Preschool/Early Learning Center

School/District

Intermediate Unit

Other Education Organization

Question Title

* 2. Organization Name

Question Title

* 3. Mailing Address:

Street

City

State

Zip Code

County

Question Title

* 4. Contact Information:

Name

Phone