SCHOOL-BASED RESILIENCY COACH

SCHOOL-BASED RESILIENCY COACH
School District Application
District Name*
County*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Superintendent's Name: *
Superintendent's Email*
example@example.com
District Contact Name*
District Contact Email*
example@example.com
District Contact Phone Number*
Please enter a valid phone number.
Number of School Included in Application *
Please provide the name of each school included in this application meeting the following criteria:

1. At least 70% of the students in the school are eligible for free or reduced lunch (FRL).

2. At least 75% of students have five or more absences within 90 school days.

3. At least 75% of students have one or more discipline referrals.

4. At least 25% of students have social-emotional issues.
School Name*
School Name*
School Name*
School Name*
School Name
School Name
School Name
School Name
School Name
School Name
School Name
School Name
School Name
School Name
Should be Empty: