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.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Modified | 0000-00-00 |
File Created | 2021-01-11 |