OREGON DEPARTMENT OF EDUCATION
255 Capitol Street NE
Salem, Oregon 97310-0203 /

Special Education Data Collection

/ Office of Student Services
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:

CONSORTIUM MANAGERS

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.

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

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

Inst. ID / Consortium Member Districts / SECC
Consortium Member / IDEA Consortium Member / Days of Operation
(i.e., M-Th) / Last Day of School (i.e., staff availability)
Consortium Member District / Additional Contact / Title / Phone / E-mail
Comments / Additional Information:

Form 581-1442-M (10/2016)