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November 21, 2017
Intent to Contract

To begin services, please complete the "Intent to Contract" form below. Completion of the“Intent to Contract” form provides immediate access to services.




Enter as YYYY-YY (Ex: 2016-17)









(Pomona Unified School District only: We will coordinate one contract through the district, but fees will be encumbered through the committing school’s budget. Please enter your 28-digit account code (e.g. 011-00000-0-1110-1000-4340-xxx-0000). If you are using categorical funds, we will provide your account code for approval by your district's Categorical Director.)


School Contacts: Please provide the name and email address of the principal and a site contact. The site contact should be someone who can be counted upon to distribute information to member teachers.







Please use the below box to list any additional site contacts. Please include the following information (separated by commas) - Site, Name, Email, Title. Please press return after each contact.

For example:

Washington MS, Jane Doe, janed@mydistrict.edu, Office Mgr
Lincoln Elem, Jack Sprat, jacks@mydistrict.edu, Tech Specialist



Verification: 

Submission of this form requests service for the 2017-18 school year. By checking the below box, service will begin immediately and a contract will be sent for signature. You are verifying that you intend to contact for membership.

Please enter the information for the person completing this form.




By checking the box below, the teachers and administrator agree to abide by copyright terms and licensing agreements that are in place.



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Contact Information

Multimedia Services
Instructional Technology Outreach
L.A. County Office of Education
9300 Imperial Highway
Downey, CA 90242


Phone: 562-922-6107
Fax: 562-940-1667
Email: media_services@lacoe.edu

Hours: 8:00 am - 4:30 pm (M-F)


Multimedia Services, Instructional Technology Outreach,
a division of Technology Services
Copyright 2013