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Event Information

Event Title:

Comprehensive Local Needs Assessment (CLNA) Series

Sub Title:

(For C12 Perkins Consortium Members)

Agency:

CESA 12

Location:

CESA 12 Online Event
Online
Ashland, WI 54806

Facility:

ZOOM Video Conferencing

Date/Time:

9/27/2023	03:45 PM - 04:30 PM
10/25/2023	03:45 PM - 04:30 PM
12/6/2023	03:45 PM - 04:30 PM

Your Name

* First Name:

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Work Information

* Organization Type:

WI Public School District

My building is not listed above. I want to enter my Primary Building.

* Primary Building Name:

* Address Line 1:

Address Line 2:

* City:

* State/Country:

For United States and Canada:

For Other Countries:

State:
Country:

* Zip:

School District not in WI
OR
Agency/Organization

My Organization is not listed above. I want to enter my Organization.

* Agency:

* Organization Name:

* Address Line 1:

Address Line 2:

* City:

* State/Country:

For United States and Canada:

For Other Countries:

State:
Country:

* Zip:

WI Private School

My Private School is not listed above. I want to enter my Private School.

* Private School:

* Address Line 1:

Address Line 2:

* City:

* State:

* Zip:

Individual/Parent/Other

* Email:

* This will be your login ID

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Ext.

Fax Number:

* Do you Require Special Accommodations?

	Yes * Please tell us about your Special Accommodations:
	No

Home Information (Used for summer / holiday mailings)

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* Home State/Country:

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* Home Zip:

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