EAS Technical Assistance Request
Please complete the form below to request Electronic Attendance System technical assistance from an Imagine Institute technical assistance provider.
Email address *
First Name *
Your answer
Last Name *
Your answer
Business Name
Your answer
Phone Number *
Your answer
SSPS/Provider Number *
Your answer
City of Residence *
Your answer
County of Residence *
What type of provider are you? *
Preferred Language (if other than English) *
I have attended an Electronic Attendance System training and have received my login credentials. *
I request that TA provider contact me to schedule an EAS technical assistance visit. *
A copy of your responses will be emailed to the address you provided.
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