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Name of your School District/School:

Your Name

Title

Telephone # (Office - Direct)

Telephone # (Mobile)

Address

City

State

% of Students on Free or Reduced Lunch

Total # of Students

# of K-8 & 9-12 Students Participating in Grant Program

Why do you think you should be selected? Important Selection Criteria: 1) Commitment to make the program a success. 2) A passionate STEM/CTE Academy Program Director

Any Comments, Suggestions or Requests