APPLICATION SHEET SCHOOL IMPROVEMENT GRANTS Legal Name of Applicant: Applicant’s Mailing Address: Samuel Brown Academy (SBA) PO Box 100 Gervais, OR 97026 District Contact for the School Improvement Name: Sylvia Valentine-Garcia Position and Office: Director of Special Programs District Office Administration Gervais Elementary School Principal Contact’s Mailing Address: PO Box 100 Gervais OR Telephone: 503.792.3803 ext. 1010 Cellular: 971.209.9497 Fax: 503.792.3809 Email address: Sylvia_garcia@gervais.k12.or.us District Superintendent (Printed Name): Telephone: Matt Henry 503.792.3803 ext. 5010 Signature of the District Superintendent: Date: X See attached documentation The district agrees to comply with all requirements applicable to the School Improvement Grants program, including the assurances contained herein and the conditions that apply to any waivers that the State and/or District receives through this application. District School Board Chairperson (Printed Name): Telephone: Steve Rush Signature of the District School Chairperson: Date: X See attached documentation
APPLICATION SHEET SCHOOL IMPROVEMENT GRANTS Legal Name of Applicant: Samuel Brown Academy (SBA) Applicant’s Mailing Address: PO Box 100 Gervais, OR 97026 District Contact for the School Improvement Name: Sylvia Valentine-Garcia Position and Office: Director of Special Programs District Office Administration Gervais Elementary School Principal Contact’s Mailing Address: PO Box 100 Gervais OR Telephone: 503.792.3803 ext. 1010 Cellular: 971.209.9497 Fax: 503.792.3809 Email address: Sylvia_garcia@gervais.k12.or.us District Superintendent (Printed Name): Matt Henry Telephone: 503.792.3803 ext. 5010 Signature of the District Superintendent: X See attached documentation Date: The district agrees to comply with all requirements applicable to the School Improvement Grants program, including the assurances contained herein and the conditions that apply to any waivers that the State and/or District receives through this application. District School Board Chairperson (Printed Name): Steve Rush Telephone: Signature of the District School Chairperson: X See attached documentation Date:
sig-app-gervais-samuel-brown-fy14.docx