Page 136 - E-Rate 2020-21 Workbook
P. 136
NEW ENTITY
E‐RATE FY 2020‐21
APPLICANT (School or Library):
Prepared by:
Date:
** SEE INSTRUCTIONS BELOW. INCLUDE SITES NOT PREVIOUSLY REPORTED WITH E‐RATE. **
a Reference Number 1 2
b Name of Site
c Owned or Leased ?
d Address
e City
f Zip
g Description of Activities and/or programs held at this site
h Opening Date
i Estimated # of Students
j Effective Date for new use
k Main phone
l Main Fax#
m Associated Campus
n Classes Held here?
o Does this site serve more than one campus?
Name of sending site (Does this site serve more than one
p Campus?)
q Add'l Phone numbers
KS0705‐June 2016
