Date of Request:*

Name of Person Requesting: *

School/Organization:

Phone Number of Person Requesting:*

Email of Person Requesting:*

Preferred Mode of Communication:

 Phone Email

Purpose of Meeting:*

Preferred Meeting Location:*

 Beaudry LAUSD Headquarters None

Suggested Date(s) of Meeting:*
mm/dd/yyyy

1)
2)
3)
4)

Other Attendees:

1)
2)
3)
4)
5)

Additional Comments:

Please contact Veronica Aguilar, if you have any questions while completing this form.

Phone: (213) 241-4657
Email: veronica.aguilar@lausd.net