Request for Assistance: LGBTQ
To ensure we understand your district/school needs, please complete this form when requesting SCCOE assistnace for LGBTQ youth support. If you need assistance completing this form, please contact Christina Arpante at pbis@sccoe.org.

Instructions:

Answer the items below, to the best of your ability.

The contact person entered on this form will be notified via email indicating the status of the request within approximately one (1) week. If additional information is needed/questions arise, a representative will reach out accordingly. Please note: We understand supporting our LGBTQ youth, and their allies, is crucial. However, the SCCOE does not have a dedicated person for LGBTQ youth supports. Nonetheless, will our collaborations with County Partners, we will provide direct, or indirect supports.

Thanks, in advance, for taking the time to provide this necessary information.
Today's date? *
MM
/
DD
/
YYYY
District *
District (Other)
Your answer
School Name (if applicable)
Your answer
Contact Person *
Your answer
Contact Person Email *
Your answer
Contact Person Phone Number (1-555-555-2121) *
Your answer
Support Needed/Request *
Your answer
Is there anything you would like to share that was not covered on this form?
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Santa Clara County Office of Education. Report Abuse