PAGE 2                                                                                                                                                                                                                                WEEB 1

        CONSORTIUM VERIFICATION FORM
Electronic versions available on website

 

 

 

Each of the undersigned certifies that they will participate in this project, that the specified obligations and responsibilities in this project will be met, and that the project will be administered by the public agency or corporation designated.

 

 

                                                                                                  ADMINISTERING ORGANIZATION

 

Organization’s Name

 

CESA 100

Project Director’s Name

Will Countussa

Project Title:

Assessing the Environmental Literacy of the Junior Class

Telephone Area/No
(777) 111-2222

 

 

                                                                                               PARTICIPATING ORGANIZATION(S)

 

 Organization’s Name

Blessings School District

 

Telephone Area/No.

(777) 444-3333

Address (Street, City, State, Zip)


5757 Utopia Drive, Perfectville WI 88888

Supplying 1/3 or More of the Total Match?
(If yes, then CEO must sign.)
o Yes                                   X No

Name and Title

Faith Goodman, Superintendent

 

Signature

Ø Faith Goodman

Date Signed
2/1/2008

 Organization’s Name

 

Reading School District

Telephone Area/No.
(777) 333-4444

Address (Street, City, State, Zip)

999 Storybook Lane, Dreamland WI 22222

Supplying 1/3 or More of the Total Match?
(If yes, then CEO must sign.)
o Yes                                   X No

Name and Title

 

Booker T. Libre, Superintendent

Signature

Ø Booker T. Libre

Date Signed
2/1/2008

 Organization’s Name

Addington School District

 

Telephone Area/No
(777) 343-4433.

Address (Street, City, State, Zip)

31416 Circle Drive, Planetown WI 55555

Supplying 1/3 or More of the Total Match?
(If yes, then CEO must sign.)
o Yes                                   X No

Name and Title

Pascal Fibonacci, Superintendent

 

Signature

Ø Pascal Fibonacci

Date Signed
2/2/2008

 Organization’s Name

Newtech School District

 

Telephone Area/No.
(777) 121-2211

Address (Street, City, State, Zip)

1234 Discovery Center Drive, Newtown WI 99999

Supplying 1/3 or More of the Total Match?
(If yes, then CEO must sign.)
o Yes                                   X No

Name and Title

Ima Inventor, Superintendent

 

Signature

Ø Ima Inventor

Date Signed
2/2/2008

 

Use a duplicate of this form if there are more than four participating organizations.                                                            WEEB (Rev.6/07)

 

PAGE 2                                                                                                                                                                                                                                WEEB 1

        CONSORTIUM VERIFICATION FORM
Electronic versions available on website

 

 

 

Each of the undersigned certifies that they will participate in this project, that the specified obligations and responsibilities in this project will be met, and that the project will be administered by the public agency or corporation designated.

 

 

                                                                                                  ADMINISTERING ORGANIZATION

 

Organization’s Name

 

CESA 100

Project Director’s Name

Will Countussa

Project Title:

Assessing the Environmental Literacy of the Junior Class

Telephone Area/No
(777) 111-2222

 

 

                                                                                               PARTICIPATING ORGANIZATION(S)

 

 Organization’s Name

Investigate Public Schools

 

Telephone Area/No.

(777) 999-0000

Address (Street, City, State, Zip)


123  Method Lane, Proveit WI 90909

Supplying 1/3 or More of the Total Match?
(If yes, then CEO must sign.)
o Yes                                   X No

Name and Title

Dependon Senses, Superintendent

 

Signature

Ø Dependon Senses

Date Signed
2/1/2008

 Organization’s Name

 

Normal Schools

Telephone Area/No.
(777) 111-1111

Address (Street, City, State, Zip)

7878 Society Lane, Ego WI 11111

Supplying 1/3 or More of the Total Match?
(If yes, then CEO must sign.)
o Yes                                   X No

Name and Title

 

Grover Status, Superintendent

Signature

Ø Grover Status

Date Signed
2/1/2008

 Organization’s Name

Recollect School District

 

Telephone Area/No
(777) 666-4444

Address (Street, City, State, Zip)

2222 Reminisce Way, Historyville WI 55555

Supplying 1/3 or More of the Total Match?
(If yes, then CEO must sign.)
o Yes                                   X No

Name and Title

Frank Reminder, Superintendent

 

Signature

Ø Frank Reminder

Date Signed
2/2/2008

 Organization’s Name

McGovern School District

 

Telephone Area/No.
(777) 575-7575

Address (Street, City, State, Zip)

5757 Democracy Lane, Politico WI, 57575

Supplying 1/3 or More of the Total Match?
(If yes, then CEO must sign.)
o Yes                                   X No

Name and Title

Bea Ruler, Superintendent

 

Signature

Ø Bea Ruler

Date Signed
2/2/2008

 

Use a duplicate of this form if there are more than four participating organizations.                                                            WEEB (Rev.6/07)

 

 

PAGE 2                                                                                                                                                                                                                                WEEB 1

        CONSORTIUM VERIFICATION FORM
Electronic versions available on website

 

 

 

Each of the undersigned certifies that they will participate in this project, that the specified obligations and responsibilities in this project will be met, and that the project will be administered by the public agency or corporation designated.

 

 

                                                                                                  ADMINISTERING ORGANIZATION

 

Organization’s Name

 

CESA 100

Project Director’s Name

Will Countussa

Project Title:

Assessing the Environmental Literacy of the Junior Class

Telephone Area/No
(777) 111-2222

 

 

                                                                                               PARTICIPATING ORGANIZATION(S)

 

 Organization’s Name

Mapes Public Schools

 

Telephone Area/No.

(777) 999-3737

Address (Street, City, State, Zip)


¼ Note Way, Drawington  WI 90909

Supplying 1/3 or More of the Total Match?
(If yes, then CEO must sign.)
o Yes                                   X No

Name and Title

Fi Edington, Superintendent

 

Signature

Ø Fi Edington

Date Signed
2/3/2008

 Organization’s Name

 

Laughin Schools

Telephone Area/No.
(777) 111-1222

Address (Street, City, State, Zip)

32 ½  Humor Court, Nowitt WI 77777

Supplying 1/3 or More of the Total Match?
(If yes, then CEO must sign.)
o Yes                                   X No

Name and Title

 

Donald Grump, Superintendent

Signature

Ø Donald Grump

Date Signed
2/5/2008

 Organization’s Name

Wisconsin Center for Environmental Education

Telephone Area/No
(715) 346-4973

Address (Street, City, State, Zip)

UW-Stevens Point, 800 Reserve Street, Stevens Point WI 54481

Supplying 1/3 or More of the Total Match?
(If yes, then CEO must sign.)
o Yes                                   X No

Name and Title

Randy Champeau, Director

Signature
Ø Randy Champeau

Date Signed
2/6/2008

 Organization’s Name

 

Telephone Area/No.

Address (Street, City, State, Zip)

 

Supplying 1/3 or More of the Total Match?
(If yes, then CEO must sign.)
o Yes                                   o No

Name and Title

 

Signature


Ø

Date Signed

 

Use a duplicate of this form if there are more than four participating organizations.                                                            WEEB (Rev.6/07)