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Type of Government Entity: <br />^ State ~ City <br />^ Borough ^ Township <br />^ Community <br />^ Other (please specify): _ <br />Contact Information: <br />Name of contact person in your department who is familiar with this grant: <br />James M. O'Meara <br />Title:_~~+a;., Email Address: jnmPara(~ri pan-1 andro.ca.us <br />Telephone: (51(l) F~77-32F,0 Fax: (510) 577-3275 <br />III. Partner Information <br />Under the COPS in Schools grant program, applicants must enter into a partnership agreement with an official for a <br />specific school or school district with general educational oversight authority in that jurisdiction. If there are going <br />to be multiple partners involved in this project, please provide the following information for each of the partners on <br />the additional partners page included in this application. However, you must designate one school official as the <br />school representative under the grant program. Please provide the information for that individual in the space <br />below. If the proposed project affects an entire school district, then the official with general educational oversight <br />over the entire school district should complete the information below. <br />Name of Partner Agency or School District: San Leaadr0 Unified School District <br />School Official NamF ° Tom H i mme 1 berg Title: Superintendent <br />Address: 14735 Juniper Street <br />City: San G.eandro State: CA Zip Code: 94579 <br />Telephone: (510) 667-3522 Fax: (510) 667-5303 <br />Email Address: thimmel@sanleandro.k12.ca.us <br />In addition, at the time the application is submitted, applicants for the COPS in Schools grant program must <br />include two written documents prepared in cooperation with the partner agency, or agencies, involved in the <br />program. <br />First, you must submit a Memorandum of Understanding (MOU) that details the roles and responsibilities of the <br />partners involved in this project. For additional information on this requirement, please refer to page 6 of this <br />application form. <br />(Second, you must also submit a COPS in Schools Narrative Addendum detailing the proposed project. For <br />additional information on this requirement, please refer to page 7 of this application form. <br />^ Town ^ County ^ Village <br />^ Territory ^ Region ^ Council <br />^ Pueblo ^ Nation ^ School District <br />COPS in Schools Application form s <br />