Official Seal of the California Department of Education

Application

21CSLA Form E: Intent to Submit an Appeal, Regional Academy, Cohort 3

Professional Learning Support Division

Welcome to the 21st Century California School Leadership Academy (21CSLA) Intent to Submit an Appeal Form. Digital signatures on this form should be from individuals representing each institution and agency with the authority to submit applications for funding. If this form is not received by 5 p.m. on September 14, 2026, with the required signatures, the appeal will not be considered.

For additional information please consult the 21CSLA Request for Applications (RFA), Cohort 3. The link is available at 21CSLA Grant Award Process.

The purpose of the Intent to Submit an Appeal is to provide applicants with the opportunity to appeal the 21CSLA Cohort 3 Award decisions. Only the lead applicant may electronically submit an appeal. Appeals shall be limited to the grounds that the California Department of Education (CDE) failed to correctly apply the standards for reviewing the application as specified in the 21CSLA Cohort 3, Regional Academy RFA. The appellant may not supply any new information that was not originally contained in the original application. All questions are required unless marked as optional.

If you have any questions regarding this form or the 21CSLA program, please contact the 21CSLA Team, Professional Learning Support Division by email at 21CSLA@cde.ca.gov.

1.	Name of Applicant

2.	Contact Person Information
	Contact Person First Name:
	Contact Person Last Name:
	Contact Person Title:
	Contact Person Office:
	Contact Person Phone Number: (999-999-9999)
	Contact Person Email Address:

3.	Fiscal Agent Information
	Fiscal Agent First Name:
	Fiscal Agent Last Name:
	Fiscal Agent Title:
	Fiscal Agent Office:
	Fiscal Agent Phone Number: (999-999-9999)
	Fiscal Agent Email Address:

Type of Entity Applying

Local Educational Agency

Institution of Higher Education

Nonprofit Educational Service Provider

5.	Applicant Partners (optional)

Please select the Geographic Region (area) your 21CSLA Regional Academy, Cohort 3 application covered. You may only select one Geographic Region area.

Kern County Superintendent of Schools - Fresno, Kern, Los Angeles, San Luis Obispo, Santa Barbara, Ventura

Placer and Sacramento County Offices of Education - Alpine, Amador, Calaveras, Colusa, El Dorado, Nevada, Placer, Sacramento, San Joaquin, Sierra, Sutter, Tuolumne, Yolo, Yuba

Riverside and San Diego County Offices of Education - Imperial, Orange, Riverside, San Bernardino, San Diego

Santa Clara County Offices of Education - Alameda, Contra Costa, San Francisco, San Mateo, Santa Clara, Solano

Shasta County Office of Education - Butte, Del Norte, Glenn, Humboldt, Lassen, Modoc, Plumas, Shasta, Siskiyou, Tehama, Trinity

Sonoma County Office of Education - Lake, Marin, Mendocino, Napa, Sonoma

Tulare County Office of Education - Inyo, Kings, Madera, Mariposa, Merced, Mono, Monterey, San Benito, Santa Cruz, Stanislaus, Tulare

7.	Please provide your full and complete written appeal, including the issue(s) in dispute, the legal authority or other basis for the appeal position, and the remedy sought. Note: The appellant may not supply any new information that was not originally contained in the original application. (? of 9,000 character maximum)

Electronic Signature

Please select the box below to declare:

I hereby certify that, to the best of my knowledge, the information in this Intent to Appeal is correct and complete. I support the proposed project and commit my organization to completing all of the tasks and activities that are described in the application.

9.	The authorizing official should type their name in the field below, which will serve as a signature that certifies agreement with the statement above.

Submit

Once you select the Submit button below, your survey responses will be sent to the CDE and you will be redirected to the 21CSLA RFA web page. An email confirmation will be sent to the Contact Person.