TLC Plan Change Request Form
Please submit a separate form for each change you are requesting.

If you need to upload supporting documents that don't fit within this form (e.g., budget spreadsheets) please email them to lora.rasey@iowa.gov

Thank you for your time and continued dedication to improving outcomes for all students.

Email address
District
Your answer
Name and Title of Person Submitting Request
Your answer
Email Address of Person Submitting Request
Your answer
Please describe the requested change.
Be sure to include the section of the grant the change pertains to. If the request expands, revises, or eliminates part of the original grant please include both the original and new language.
Your answer
Please describe the rationale for the requested change.
Your answer
Please describe the process and groups involved in determining the change.
Your answer
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
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