Community Partner Suggestion Form

1
URGENT: PLEASE READ BEFORE PROCEEDING!

Vendor applications will be reviewed for eligibility to serve the needs of the School(s) community. Approval will be granted upon a successful review of the following:

- Service descriptions, cost, and duration

- Completion of California Department of Justice background checks in compliance with Education Code section 45125.1

– Completed W-9 - Taxpayer Identification Number and Certification Form

– Certificate of Insurance: General liability insurance coverage, including bodily injury and property damage, meeting the required coverage limits of $1,000,000/$2,000,000.

If you do not believe the suggested vendor can meet these requirements, please do not proceed with the suggestion form.
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Name* This field is required.Please tell us who is filling out this form.
First Name
Last Name
3
What is your role?* This field is required.Please tell us more about who you are.
Teacher
Parent/Guardian
Student
School Administrator
Vendor
4
What is your email address?Teachers and administrators should provide an email address so we may contact you with updates or questions. This information is optional for families as all communications will be provided through the Teacher.
example@example.com
5
Please provide your Teacher's full name.Please provide your Teacher's name so we can provide them with updates about your request. Teachers and school administrators may skip this question.
6
Tell us more about the vendor you would like to suggest. * This field is required.Please provide some brief information about the vendor so we may get in contact with them about possibly becoming a community partner with your school.
Business/Vendor Name
Business/Vendor Website URL
Contact Email
Please Select
Please Select
Currently receiving services and paying out of pocket.
Attended services before and would like to again.
No experience with this vendor's services, but would like to give them a try.
Current Status with Vendor (Select One)
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What service are you requesting? * This field is required.Please list either the general services you would like this vendor to provide for students or list a specific class/lesson you would like to pay for with planning amounts.
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Service Cost* This field is required.Please provide an estimated dollar amount or range for the requested services.
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Service Frequency* This field is required.Please select the frequency by which this vendor bills for their services. *Please note the School may require different payment options than direct-pay individuals for Charter school students, however, providing the estimated frequency will assist with preliminary school approvals.
Per Month
Per Session
Per Semester
Per Week
Should be Empty: