Good Cause Transfer (GCT)

Good Cause Transfer (GCT)

Thank you for submitting your request for a Good Cause Transfer (GCT).

To expedite the staffing process and ensure that Community Operations can make an informed decision regarding your request, we require additional information.

ATTENTION: All fields must be completed prior to submission.

The submission of a GCT request is not an assurance that your organization has met the criteria for a GCT.

What is your site's name?*

What is your site's ID number?*

Provide your site’s email address.*

Salutation*

Select

Provide the Director/Site Manager’s name. (TDA defines Site Managers as the individual who is responsible for day-to-day activities at the site.)*

Enter a First and Last Name.

Note: Community Operations will not make a change to a binding agreement with a person who is not a designated representative of the site.

Please provide the Director/Site Manager's official title.*

What is the Name of your current sponsor?*

What is your Sponsor's CE ID Number?*

Site Type*

Select

What is the physical address of your site's location?*

City*

Zip Code*

What is your site’s mailing address for official correspondence?*

Note: TDA will only mail correspondence to addresses listed on the site application.

Mailing City*

Mailing State*

Select

Mailing Zip Code*

Name of the Education Service Center (ESC) Representative you have consulted with before contacting TDA?*

Select

ESC Region Number

Select or enter value

Reason for the GCT request:*

Note: If you select “Another reason not listed above” you must provide a detailed summary of the circumstances that had led you to request GCT. Supporting documentation of emails, telephone call summaries, and other documents that support your GCT request.

Select

Describe the other reason for your Good Cause Transfer request.*

What date did this action/event occur?*

Have you signed agreements with another sponsor, other than the one with which you have a current Permanent Agreement? (If you have signed an agreement with another sponsor, attach these Permanent Agreements, if applicable.)*

Note: If you have additional agreements, you must upload those signed agreements. Attach these Permanent Agreements, if applicable, at the end of this form.

Yes

Provide the name of all other Sponsors which you have signed agreements.*

Do you have additional sites affiliated or not affiliated with your organization?*

Yes

If “Yes”, you must provide the site name and complete address below:*

When was your last claim for reimbursement submitted/filed with your sponsor?*

Have you communicated with your Sponsor that you intend to request a GCT?*

Note: The site must provide 30 days written notice if terminating their permanent agreement with current sponsor without mutual consent.

If you are terminating your agreement to transfer to another sponsor, the intent to terminate must be written and submitted with 30-day notice before the submission of the GCT.

Yes

I have upload documentation that supports my GCT request.*

Note: You must attach documentation to support your GCT request.

I have uploaded my "Other" Permanent Agreements below.*

File Upload

Drag and drop files here or

Please Read:

Ensure ALL fields have been completed thoroughly and accurately.
If your request is returned for any reason, your organization will have 72 hours to return the missing information/attachments.
If this incomplete request is not returned to Community Operations within 72 hours, your organization will be required to restart the GCT request process. Requests are processed in the order in which they are received.
Please be advised that if your request is returned to you for any reason, and you resubmit, your request will be placed back in queue.
After Community Operations has received all required information and documentation, Community Operations will begin reviewing the GCT request. This may include contacting and interviewing involved parties to validate the information.
The submission of a GCT request is not an assurance that your organization has met the criteria for a GCT.

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