Grade Level Service Request Form

***Note: This form is no longer active for service requests. Please contact Anita Rodriguez if you have any questions. Thank you.***

This form is for requesting a service on behalf of ALL teachers in your grade. If you are requesting an individual service use the Teacher Service Form.

Lead Teacher Information

NOTE: Required fields are indicated with an *




Home Phone*:


Grade*:
Number of teachers you are applying on behalf of:*:
Class size (0 if you are not a teacher)*:
Would you like to request a scholarship? Yes
Please read the scholarship information (opens in new window) to see if your school qualifies.

School Information

Processing your request will go easier if all the teachers at your school use the same full school name. Abbreviated and shortened school names can slow processing. Thank you!





School District:

Other Teachers Information

Teacher 1 First Name:
Teacher 1 Last Name:
Teacher 1 Email:
Teacher 1 Class Size:

Teacher 2 First Name:
Teacher 2 Last Name:
Teacher 2 Email:
Teacher 2 Class Size:

Teacher 3 First Name:
Teacher 3 Last Name:
Teacher 3 Email:
Teacher 3 Class Size:

Teacher 4 First Name:
Teacher 4 Last Name:
Teacher 4 Email:
Teacher 4 Class Size:

Teacher 5 First Name:
Teacher 5 Last Name:
Teacher 5 Email:
Teacher 5 Class Size:

Teacher 6 First Name:
Teacher 6 Last Name:
Teacher 6 Email:
Teacher 6 Class Size:

Teacher 7 First Name:
Teacher 7 Last Name:
Teacher 7 Email:
Teacher 7 Class Size:

If any class size is over 32 students, please explain in the comments area.

Type of Service Requested

For more information about each service type , please see our Service Brochure (opens in new window).

Service Type Requested*:

Alternative Service Type Requested:

Month Requested*:

Alternate Month(s) Requested:
[To select multiple months, use Ctrl+Click (Windows) or Command(Apple)+Click (Mac)]

Requests are accepted on a first-come, first-served basis, and will not be processed if this form is not complete.

If we cannot fulfill your request you will be placed on our waiting list.

We do not accept applications by mail, phone or fax!

By clicking the button below you will be submitting your Online Service Application Form and accepting the Service Agreement outlined above. Please only click/submit once. You should be transferred to a confirmation page, and you will receive a detailed confirmation email of your submission. We strongly recommend that you save that confirmation email for your records.

***Note: This form is no longer active for service requests. Please contact Anita Rodriguez if you have any questions. Thank you.***