21st CCLC Cohort 13 Intent To Apply

21st CCLC Cohort 13: Intent to Apply

Submit this form to indicate your intention to apply for Cohort 13 of the 21st CCLC program. Submission of this form is not binding. Contact the Indiana Department of Education via email at OSTprogram@doe.in.gov with additional questions on this form of the 21st CCLC program.

Name of School District or Organization *

Organization Type

City*

County*

Contact Name*

First NameLast Name

Contact Email Address*

Confirmation Emailexample@example.com