FCCLA/State Farm Partnership Report

Question Title

* 1. School Name:

Question Title

* 2. School Address:

Address

City/Town

State/Province

ZIP/Postal Code

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* 3. Teacher/Adviser's Name:

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* 4. State Farm Agent's Name:

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* 5. State Farm Agent's Contact Information:

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 6. Date Contacted:

Date / Time

Date

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* 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.

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* 8. Agent's response:

Agreed to participation.

Declined participation.

Did not reply to the request.

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:

FCCLA/State Farm Partnership Report

Question Title

* 1. School Name:

Question Title

* 2. School Address:

Question Title

* 3. Teacher/Adviser's Name:

Question Title

* 4. State Farm Agent's Name:

Question Title

* 5. State Farm Agent's Contact Information:

Question Title

* 6. Date Contacted:

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.

Question Title

* 8. Agent's response:

Question Title

* 9. If the Agent participated, briefly describe their role in the event and the date that it took place.

Question Title

* 10. Any additional information you would like to add: