Education Technology JPA Associate Membership Application

**This form must be accompanied by the executed Associate Membership Agreement. A template board resolution authorizing membership with the Education Technology JPA is available on the Becoming A Member page.

Public agencies with a valid CDS Codes will be provisionally approved for membership upon receipt of the completed Application and Associate Membership Agreement. Formal action to approve new Associate Members will occur at the next regularly scheduled Ed Tech JPA board meeting.

Name or Organization

Full Name of Designated Representative

Title

Email of Primary Contact

Street Address

City

State

County

Zip

Phone

Ext

Fax

Type of Public Agency as defined by Government Code Section 6500 et seq.:

Public School District

Other K-12 School

County Office of Education

Community College District

Other Public Agency

Is this K-12 School a Charter?

If "other," please specify

CDS Code

Current Enrollment:

Please list RFPs/Contracts your organization is interested in leveraging

Upload Executed Associate Membership Agreement

One file only.
2 MB limit.
Allowed types: pdf.

Additional Information

If you would like to add additional people from your organization, please enter the Name, Title, and Email Address for additional User Names you would like issued for this Associate Member.

Chief Business Officer

Chief Business Officer Email Address

Chief Technology Officer

Chief Technology Officer Email Address

Procurement Director

Procurement Director Email Address

Superintendent

Superintendent Email Address

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Education Technology JPA Associate Membership Application

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