<p> 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</p><p>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.</p><p>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).</p><p>Institution ID: Last Day of School (i.e., staff availability):</p><p>Agency Name: Days of Operation (i.e., M-Th): (District – ESD - EI/ECSE Program) District Address**: District Phone: Superintendent</p><p>Name: Phone: Ext.: (Area Code) Email: Please place my name on the SEDC Listserv.</p><p>Special Education Director/Coordinator</p><p>Name: Phone: Ext.: (Area Code) Email:</p><p>Special Education Data Contact/Secretary (Person who submits SECC/June Exit Data) Name: Phone: Ext.: (Area Code) Email:</p><p>Special Education Business Manager</p><p>Name: Phone: Ext.: (Area Code) Email: Please place my name on the SEDC Listserv.</p><p>Child Find Contact (Person who submits Child Find Data)</p><p>Name: Phone: Ext.: (Area Code) Email:</p><p>Comments / Additional Information:</p><p>*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.</p><p>Please complete and return to: Joanne Manning Office Student Services 255 Capitol Street NE, Salem, Oregon 97310-1206 Email: [email protected]</p><p>Form 581-1442-M (10/2016) C O N S O R T I U M M AN A G E R S</p><p>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.</p><p> Check the SECC CM box if your agency reports the Special Education Child Count data for the member districts.</p><p> Check the IDEA CM box if your agency acts as the fiscal agent for the member districts.</p><p>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)</p><p>Consortium Member District Additional Contact Title Phone E-mail</p><p>Comments / Additional Information:</p><p>Form 581-1442-M (10/2016)</p>