Date: ______________________

Name of School:___________________________________________

Address: ________________________________________________

Phone: ____________________ Fax:_______________________

Name of Principal:_________________________________________

Number of Pupils in School: ___________________

Number of Sections: K ___ 1___ 2 ___ 3 ___ 4 ___
                                5 ___ 6 ___ 7 ___ 8 ___ 

Members of your School’s Core Group

Names of STAFF who will be participating in
organizing and implementing RAV:

Name                                          Position

_________________________          _________________________

_________________________          _________________________

_________________________         __________________________

 
Names of PARENT LEADERS who will be participating in
 planning, organizing, and implementing RAV:

Name                                          Position

________________________          __________________________

________________________          __________________________

 
Please mail this application form to:

RAV
4506 Riverside Drive
Richmond, VA 23225 

Thank You!   We look forward to working with you!