State Department of Education Contacts Form

State Department of Education Contacts

State of ___________________ Date _______

OMB #: 0970-0531

Expiration Date: 7/31/22

Instructions: The purpose of the State Department of Education Contacts Form is to obtain key State contacts and information on upcoming legislation or events relevant to Head Start in the State. The information will be used when reaching out to a State, particularly during travel from the Office of Head Start (OHS) to those States. The contact information provided should be for State officials and publicly available.

Head Start Collaboration Office (HSCO) Director Name_______________________

Email ______________________Phone________________

Name of Department where HSCO is located _______________________________________________

HSCO Relationship to Department of Education: ___Excellent ___Good ___Satisfactory ___ Limited

Name of Department of Education Office __________________________________________________

Early Childhood Contact

Name_________________________________ Title _________________________________________

Email__________________________________Phone________________________________________

Name of Department where contact is located______________________________________________

____HSCO has an existing working relationship with the above contact

____The contact above is from a directory, HSCO has no working relationship them

Additional early childhood contact based on HSCO having a working relationship with this person

Name _______________________ Title___________________________

Email ________________________Phone__________________________

Elementary Education Contact

Name_________________________________ Title _________________________________________

Email__________________________________Phone________________________________________

Name of Department where contact is located______________________________________________

____HSCO has an existing working relationship with the above contact

____The contact above is from a directory, HSCO has no working relationship them

Additional elementary education contact based on HSCO having a working relationship with this person

Name _______________________ Title___________________________

Email ________________________Phone__________________________

Superintendent/Secretary of Education Contact

Name_________________________________ Title _________________________________________

Email__________________________________Phone________________________________________

Name of Department where contact is located______________________________________________

____HSCO has an existing working relationship with the above contact

____The contact above is from a directory, HSCO has no working relationship them

Additional Superintendent/Secretary of Education contact based on HSCO having a working relationship with this person

Name _______________________ Title___________________________

Email ________________________Phone__________________________

Other Potential Contact

Name_________________________________ Title _________________________________________

Email__________________________________Phone________________________________________

Where the Department is located________________________________________________________

____HSCO has an existing working relationship with the above contact

____The contact above is from a directory, HSCO has no working relationship them

Additional other contact based on HSCO having a working relationship with this person

Name _______________________ Title___________________________

Email ________________________Phone__________________________

Possible Legislation/Budget Upcoming that Could Impact Head Start

Name of Bill___________________________________________________________________________ Brief Description ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Concerns/Possible Head Start Impact of Legislation/Budget

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Major Meetings/Events in 2019-2020 to potentially attend (month and date if known and who will be attending from the State)

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Paperwork Reduction Act Burden Statement: This collection of information is voluntary. Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.