School-Based Health Centers Planning Grant
Letter of Intent to Apply - Round 2
Date of Submission
*
-
Month
-
Day
Year
Date
Name of LEA:
*
LEA's Unique Entity Identifier (UEI):
*
Locale:
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Rural
Urban
Suburban
Which federally-identified or State of Georgia classification does your school of choice have? (select all that apply)
*
CSI
TSI
Promise
Rural
# of Schools in LEA:
*
LEA Total Enrollment
*
Name and Title of Person to Contact Regarding this Proposal:
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Full Name
Title
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
How did you learn of this funding opportunity?
*
In one or two paragraphs please state your intent to apply for a School-Based Health Center planning grant and why.
*
Please verify that you are human
*
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