Request For CCEE Assistance Intake Form
Agency Needing Service
*
Name
*
First Name
Last Name
Title
*
Email
*
example@example.com
Office Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Mobile Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Confirmation that district is eligible through the following minimum criteria (check all that apply)
*
At risk of qualifying for state intervention
A presenting need that CCEE can address in nine months or less
A number of outside improvement partners are currently engaged in providing assistance, including the local county office of education and Geographic Lead, in addition to any other additional improvement partners
Description of Need Aligned with LCFF and LCAP State Priorities
*
Goals for Assistance
*
Description of Services/Project Deliverables
*
Please verify that you are human
*
Submit
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