PRELIMINARY INTENT TO APPLY FORM
Ninth Grade Success Initiative

Name of District	

Name of Superintendent	

Mailing Address	

City, Zip	

Phone	

District Contact Person	

Phone: 			  Fax:  _______________  E-mail: 	

Your response to the following is non-binding.  Please check one of the following blanks:

_____	Yes, our district intends to apply for funding.

_____	No, our district does not intend to apply for funding.

If you answered “Yes,” please respond to the following:

_____	Number of at risk 9th Grade Students identified in the district’s PEIMS Report for 
	1998-99.

The review and scoring of applications will occur either via mail or through an on-site process.  
If anyone in your district would be willing to serve as a reviewer, please list name(s), job title(s), phone, and fax number(s) below.

1.  	

2.  	

3.  	

This form must be received at the Texas Education Agency no later than September 24, 1999.  Please mail or fax this form to:

	Geraldine Kidwell
	Curriculum and Professional Development
	Texas Education Agency
	1701 North Congress Avenue
	Austin, TX 78701
	Office: 512/463-9581; Fax: 512/463-8057