PART 1 - PRINCIPAL INFORMATION (To be completed by principal)

The application is due by May 1, 2024.

PRINCIPAL & SCHOOL INFORMATION

First Name *

Last Name *

School Email *

School Telephone (include area code) *

School Name *

School Number (IDOE 4-digit school #) *

School Street Address *

Address Line 2

School City *

State *

Zip Code *

County: (Select from dropdown) *

Please select all grade levels at your school. *