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* 1. Subjects to be provided? (Check both if both are needed)

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* 2. Type of services needed?

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* 3. Does each school location have a dedicated room for In-School tutoring from Monday to Friday?

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* 4. Does each school location have a dedicated room for After-School tutoring for 2-4 days a week?

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* 5. Does each school location have a dedicated room for Summer Bridge tutoring for 2-4 days a week?

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* 6. Does each campus location have a dedicated liaison for the Beacon Hill Partnership?

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* 7. Does your school have a dedicated budget for services?

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* 8. School Campus:

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* 9. 1st Point of Contact Name:

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* 10. Office or Cell Number:

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* 11. Projected number of students to be served:

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* 12. Projected # of district campuses to be served:

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* 13. Grades to be served:

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* 14. Tentative Start Date:

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* 15. If known, what is the budget for services?

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* 16. What is the budget per program? (Math or Reading)

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* 17. What is the budget per student? (Math or Reading)

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* 18. What is your preferred date and time to meet via Zoom to discuss this program?

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* 19. How did you hear about our program?

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