First Name * Last Name * E-mail * City / Town * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Phone * With what organization or agency (e.g., school district) are you affiliated? * What is your role in your school/district/organization? * - Select -Board MemberCommunity MemberFaculty MemberFor-Profit Staff MemberGovernment Staff MemberNon-Profit Staff MemberPara-ProfessionalParent/GuardianPolicy MakerRelated Service PersonnelResearcherSchool AdministratorTeacher Please briefly describe the reason you are contacting the Great Lakes Equity Center/Midwest and Plains Equity Assistance Center for assistance including any concerns about which you would like our staff to be aware. * In a couple of words, please describe the topic of your request: * How did you find out about the Great Lakes Equity Center/Midwest and Plains Equity Assistance Center? * - Select -Referred by a friend or colleagueWeb SearchSocial MediaEmail from the CenterCenter publicationMeeting/ConferenceOther (please specify) If you were referred by a colleague or friend, please enter their name and organization below: * Is this your first time requesting service from an Equity Assistance Center? * - Select -YesNoI don't know Is this request related to any challenges associated with COVID-19? * Yes No Leave this field blank CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Submit
