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* 1. School Name:

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* 2. School Address:

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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:

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* 6. Date Contacted:

Date / Time

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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:

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

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

0 of 10 answered
 

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