Early Learning Liaisons Update Form

Please provide the following contact information for Early Learning District Liaison positions.

OSPI may use Coordinators' contact information in public-facing materials.

Select contact to update

District, Entity, or Affiliation

School or Facility

Person to remove

First Name

Last Name

Person to add

First Name

Last Name

Title

Primary phone

Ext:

Alternate phone

Ext:

Email

Address

City/Town

State/Province

ZIP/Postal Code

New HIB Compliance Officer

Name

Title

Email

Phone

Additional Information for Homeless Liaisons

Indicate the number of hours per week the Homeless Liaison is paid specifically to perform liaison duties.

Number of hours per week the Homeless Liaison performs liaison duties.

Remarks

Remarks for HIB Compliance Officers

Additional Information for District Truancy Liaison

Indicate the number of hours per week the Truancy Liaison performs liaison duties.

Indicate the number of hours per week the Truancy Liaison is paid specifically to perform liaison duties.

MOU Signature Date

RCW 28A.225.010 requires districts greater than 300 students to have a memorandum of understanding with your local juvenile court jurisdiction to operate Community Engagement Boards.

Community Engagement Boards are scheduled

As needed

1/week

2/month

Other

N/A

Secondary person to add

First

Last

Suffix

Title

Primary phone

Ext:

Alternate phone

Ext:

Email

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Person submitting form

First Name

Last Name

Email of person submitting form

Early Learning Liaisons Update Form

Person to remove

Person to add

Person submitting form

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