Community Flyer – Request for Approval Please complete all highlighted areas.

Organization/Group Event Date of Request Person Making Request Phone Number Email Address Mailing Address City, State, Zip All Schools Where Flyers Are Requesting to be Placed (Check all boxes that apply)

☐ALL ☐La France Elementary ☐Mt. Lebanon Elementary ☐Pendleton Elementary ☐Townville Elementary ☐Riverside Middle ☐Pendleton High ☐District Office

Date of Event Suggested Posting Date Suggested Ending Date Upcoming events included on our website, bulletin boards, or other forms of broadcast, do not indicate endorsement of Anderson School District Four.

Section to be filled out by Superintendent

Approved ☐ Joanne S. Avery, Ph.D., Superintendent

Not Approved

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Date Form Revised: 8.24.15