LGBTQ+ Service Request Form
To ensure  your district/school needs, please complete this form when requesting the Santa Clara County Office of Education (SCCOE) LGBTQ+ Services.

SCCOE offers general education/awareness numerous LGBTQ+ topics. Presentations can be tailored for students, parents, staff or a combination thereof. Virtual Presentations will be conducted via Zoom.

Full catalog list can be found here:

Instructions:   * A new form must be completed for each service requested.*

Please answer the items below, to the best of your ability.

The contact person noted will be notified via email indicating the status of the request within approximately one (1) week. If additional information is needed/questions arise, the coordinator of LGBTQ+ District Resources and Supports will reach out accordingly.  

Please be advised all requests will be fulfilled based upon the coordinator of LGBTQ+ District Resources and Supports' availability.

Thanks, in advance, for taking the time to provide this necessary information.

Email *
Email *
Are you requesting an in-person or virtual service?
 *
Please provide a brief description of the service request
 *
School Name *
Tentative Dates of Service (please allow two weeks for planning and preparation)
 *
Tentative Time of Service
 *
Time
:
Contact Person
 *
Contact Person Email
 *
Contact Person Phone Number 
 *
Grade *
Required
A copy of your responses will be emailed to .
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