If you would like to send your affidavit online, please fill in the requested information on the form below and click on the “Submit this form” button. The information to complete this form can be found in an e-mail or letter regarding affidavits that you received.

If you have questions please call Patty Tharp at (209) 547-2226 or e-mail ptharp@modbee.com.

Teacher Affidavit

Teacher Name *

First

Last

Title *

Email Address *

Phone Number *

###

####

School Name *

School Address *

Street Address
Address Line 2
City	State	Zip Code

Agreement *

I agree the information in the affidavit is complete and accurate. These copies/licenses were ordered, received and used for access to The Modesto Bee electronic edition Monday - Sunday as part of the curriculum for the dates below.

From to

During this time, we received copies/licenses of The Modesto Bee (not to exceed the number of students per clas) for use by the Students in my classroom(s).

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