StrongStart BC Program Location or Name Change

School District (name and number):(Required)

Existing StrongStart BC Location - School Name:(Required)

Existing StrongStart BC - Program Name:(Required)

Existing StrongStart BC - Program number:(Required)

Reason for requesting location change:

New Location - School Name (please provide full name):

Preferred name of new StrongStart BC location. Program naming conventions usually reflect either a host school or community location, e.g., StrongStart Center

New Location School Address:

Street Address Address Line 2 City Postal Code

Distance between existing and proposed locations:

Date - Proposed change in effect:

Latest EDI scores and neighbourhood where the school is located:

Estimated number of children 0-5 years in the community/neighbourhood of new location:

It is recommended that districts consult with their local Family Resource Program and/or community agencies (if applicable). Please identify community early childhood development partners and describe how they were consulted:

Additional rationale for selecting this new location (if applicable):

Submitted by:(Required)

First Last

Title

Phone

Date submitted:

This field is for validation purposes and should be left unchanged.