Unified Champion Schools Registration & Funding Application
School Name: *
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School Address: *
Street:
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*
City:
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*
Zip Code:
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School District: *
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School Contact Name (Primary Liaison for Unified Champion Schools) *
*First Name:
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*
*Last Name:
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*
*Email:
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*
Phone:
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Role or Position within the School District: *
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Total Number of Students in your school: *
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OPTIONAL: Additional School Coordinating Team Member. Please enter name and email address, if available:
First Name:
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Last Name:
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Email:
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OPTIONAL: Additional School Coordinating Team Member. Please enter name and email address, if available:
First Name:
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Last Name:
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Email:
Your answer
OPTIONAL: Additional School Coordinating Team Member. Please enter name and email address, if available:
First Name:
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Last Name:
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Email:
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Is this school NEW to Unified Champion Schools? (Is this the first year that the school has been involved?) *
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