Letters of Intent due Friday, January 13, 2017, by 11:59 pm.

1.Please complete the information requested below to indicate your intention to apply for the Tiered Intervention Grant 2017.(Required.)

Name of LEA:

Recipient Schools:

Name of Authorized Representative:

Name of Contact for the Proposal:

Contact Telephone Number:

Contact E-mail Address

2.I affirm that I am the named authorized representative from the LEA, or that the named authorized representative is aware and has approved of the intent to apply for the grant opportunity.(Required.)

YesNo