OREGON DEPARTMENT OF EDUCATION Office of Student Services 255 Capitol Street NE Salem, Oregon 97310-0203 Special Education Data Collection District / Consortium Manager* Contact Information

It is important that each agency has an up-to-date form on file with OLSS. It is the responsibility of each agency to submit a new form when an update is needed. This form is available online at http://www.ode.state.or.us/search/page/?id=47. The information collected on this form is used for various data collection communications throughout the year.

IMPORTANT – To ensure maximum communication regarding special education data collections all Special Education Directors, SpEd Contacts/Secretary, and Child Find Contacts will be placed on the Special Education Data Collection (SEDC) Listserv (Superintendents and SpEd Business Managers upon request).

Institution ID: Last Day of School (i.e., staff availability):

Agency Name: Days of Operation (i.e., M-Th): (District – ESD - EI/ECSE Program) District Address**: District Phone: Superintendent

Name: Phone: Ext.: (Area Code) Email: Please place my name on the SEDC Listserv.

Special Education Director/Coordinator

Name: Phone: Ext.: (Area Code) Email:

Special Education Data Contact/Secretary (Person who submits SECC/June Exit Data) Name: Phone: Ext.: (Area Code) Email:

Special Education Business Manager

Name: Phone: Ext.: (Area Code) Email: Please place my name on the SEDC Listserv.

Child Find Contact (Person who submits Child Find Data)

Name: Phone: Ext.: (Area Code) Email:

Comments / Additional Information:

*Consortium Managers must list consortium member district(s) on the next page. ** District Address will be used for all correspondence and will appear on the Special Education Report Card.

Please complete and return to: Joanne Manning Office Student Services 255 Capitol Street NE, Salem, Oregon 97310-1206 Email: [email protected]

Form 581-1442-M (10/2016) C O N S O R T I U M M AN A G E R S

Please provide the information in the table below for each Consortium Member District (CM). Special Education Director, Special Education Data Contact/Secretary and Child Find Contact information on page 1 will be used for the member districts unless you note otherwise. Please use the space below to add additional member district contact information.

 Check the SECC CM box if your agency reports the Special Education Child Count data for the member districts.

 Check the IDEA CM box if your agency acts as the fiscal agent for the member districts.

SECC IDEA Days of Last Day of School Inst. ID Consortium Member Districts Consortium Consortium Operation (i.e., staff availability) Member Member (i.e., M-Th)

Consortium Member District Additional Contact Title Phone E-mail

Comments / Additional Information:

Form 581-1442-M (10/2016)