Appendix C - Application Cover Page and Contact Information

Progress is not saved in this system. You will need to start over if you leave or close the appendix page.

You have errors on your form!

Applicant Information

Name of LEA Applicant *

Mailing Address *

City *

State *

Zip *

CD/CDS Code *

Contact Information (Person responsible for day-to-day grant oversight)

Name of LEA Grant Lead *

Title *

Telephone *

Email *

Contact Information (Person authorized to sign grant award agreement)

Name of LEA Signatory *

Title *

Telephone *

Email *

LEA Data Agent Information (Person responsible for grant data oversight)

Name of Data Agent *

Title *

Telephone *

Email *

LEA Fiscal Agent Information (Person responsible for grant budget oversight)

Name of Fiscal Agent *

Agency *

Telephone *

Email *

Consortium

Consortium Application

List LEAs in the consortium, if the partner LEA is outside of the lead applicant LEA’s county or district consortium, or if a consortium of charters.

Reset Appendix B Appendix D