1. Contract Information

Please fill out the following contact information for the school applying for the funding assistance for Student Assistance Program.  Please include school administration, business administrator, and community based organization, if applicable. *NOTE: An application is required for each Student Assistance Program and must be submitted by school principal. 

Please see the PDF of the full application HERE

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* 1. Name of contact person for application

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* 2. Email address

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* 3. School District

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* 4. Name of School

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* 5. Address

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* 6. Name of Building Principal

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* 7. Building principal's email address

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* 8. Name of Superintendent

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* 9. Superintendent's email address

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* 10. Name of Business Administrator

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* 11. Business Administrator's email address

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* 12. Name of Contractor (if services will be provided via contract)

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* 13. Name of community-based prevention organization assisting with the application, if applicable 

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* 14. Contact person at community-based prevention organization, if applicable

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* 15. Email address for contact person at community-based prevention organization, if applicable

 
 20% of survey complete.

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