Contact Information Form (CIF)

All 21st CCLC grantees must provide contact information for the following persons:

  • Superintendent or Executive Director of the Local Education Agency (LEA)
  • Fiscal Manager
  • Primary contact person
  • Secondary contact person

If any names or contact information for a 21st CCCL grantee are changed, a new Contact Information Form (CIF) must be completed and submitted

Note: the primary and secondary contacts must be different individuals

Directions on Completing the CIF

  • The CIF is completed at the time of application and it is the responsibility of the grantee to submit an updated CIF to PDE with any subsequent contact information changes
  • All information is important, and should be completed accurately and fully (i.e. phone extensions)
  • The Primary and Secondary Contacts are used for day-to-day grant related correspondence and may not be the same individual
  • The Primary Contact is used as the delegate for federal PPICS grant reporting
  • The form should be completed by the individual with signatory authority


CIF Submission
Submit completed forms simultaneously to:

  • Susan D’Annunzio, Pennsylvania Department of Education
  • Your Program Officer
  • Your CSC TA Provider

Download the Contact Information Form