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