Wisconsin Department of Public Instruction district assessment coordinator (dac)




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Wisconsin Department of Public Instruction

DISTRICT ASSESSMENT COORDINATOR (DAC)
UPDATE FORM

PI-1274-DAC (Rev. 08-11)



INSTRUCTIONS: This form must be completed by all district assessment coordinators each school year. The update form may printed and filled out by hand or saved to your computer, filled in electronically, and printed. Be sure to have the district administrator sign the form before sending it to DPI by mailing, scanning then emailing, or faxing.

WISCONSIN DEPARTMENT OF PUBLIC INSTRUCTION

OFFICE OF EDUCATIONAL ACCOUNTABILITY

P.O. BOX 7841

MADISON, WI 53707-7841

E-mail: oeamail@dpi.wi.gov


or
Fax: (608) 266-8770







GENERAL INFORMATION







CESA No.

  


District No.

    


District Name

     





Name of District Assessment Coordinator

     


Title

     





Email

     


Phone Area/No./Ext.

      Ext.     



Fax No. Area/No.

     





Mailing Address

     





Shipping Address

     





City

     


State

  


ZIP Code

     








SIGNATURE







District Administrator’s Name Please print

     





District Administrator’s Signature



Date Signed


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