FCCLA/State Farm Partnership Report Question Title * 1. School Name: OK Question Title * 2. School Address: Address Address 2 City/Town State/Province ZIP/Postal Code OK Question Title * 3. Teacher/Adviser's Name: OK Question Title * 4. State Farm Agent's Name: OK Question Title * 5. State Farm Agent's Contact Information: Address Address 2 City/Town State/Province ZIP/Postal Code Email Address Phone Number OK Question Title * 6. Date Contacted: Date / Time OK Question Title * 7. Briefly describe your request of the Agent...i.e. Classroom Presentation, Community Service Project Partner, School Assembly Sponsor, FCCLA Chapter Meeting Guest Speaker, etc. OK Question Title * 8. Agent's response: Agreed to participation. Declined participation. Did not reply to the request. OK Question Title * 9. If the Agent participated, briefly describe their role in the event and the date that it took place. Event: Date of the Event: Date the Agent declined participate or did not reply to request: OK Question Title * 10. Any additional information you would like to add: OK THANK YOU FOR THE INFORMATION. CLICK HERE WHEN FINISHED.