Official Seal of the California Department of Education

Application

21CSLA Form A: Intent to Submit an Application, Regional Academy, Cohort 3

Professional Learning Support Division

Welcome to the 21st Century California School Leadership Academy (21CSLA) Intent to Submit an Application Online Form. Only applicants that submit this form by the deadline will be able to submit an application for the 21CSLA program, Cohort 3. 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 May 27, 2026, with the required signatures, the proposal will not be considered for funding. Submitting an Intent to Submit an Application Online Form does not require an applicant to submit an application.

For additional information please consult the 21CSLA Request for Applications, Cohort 3 on the 21CSLA Grant Award Process.

You must select the Save Responses button on the first page of the online application if you do not intend to complete the application in one session. Once you select the Save Responses button, a web page will appear that asks for your email address. You will receive an email with a unique URL (web address) for entrance back into the application. It is recommended that you copy the URL on the application web page and save it in case you do not receive the confirmation email. This address will allow you to return to your application. Do not use the Back button until you receive the unique URL. Otherwise, responses will be cleared

The purpose of the Intent to Submit an Application Online Form process is to (1) provide the California Department of Education (CDE) with information to plan adequately for the review of applications, and (2) to provide an opportunity for potential applicants to ask questions that may be of interest or concern to all applicants.

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
	First Name
	Last Name
	Title
	Office
	Phone Number (999-999-9999)
	Email Address

3.	Fiscal Agent Information
	First Name
	Last Name
	Title
	Office
	Phone Number (999-999-9999)
	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 will cover. You may only select one Geographic Region area to cover.

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

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 Submit 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.

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

Print and Submit

For a record of your responses, please select the Print Responses button below. You must print your responses before you select Submit. You will not be able to access your responses after selecting Submit.

Selecting Print Responses will open a separate window for printing options. Remember to return to this survey window to select Submit. Your responses will not be submitted and will be lost if you close this survey window before selecting 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 home web page. An email confirmation will be sent to the Contact Person.