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:
Your answer
Last Name:
Your answer
Email:
Your answer
OPTIONAL: Additional School Coordinating Team Member. Please enter name and email address, if available:
First Name:
Your answer
Last Name:
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Email:
Your answer
Is this school NEW to Unified Champion Schools? (Is this the first year that the school has been involved?)
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