Wisconsin Department of Public Instruction district technology coordinator (dtc)




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Wisconsin Department of Public Instruction

DISTRICT TECHNOLOGY COORDINATOR (DTC)
UPDATE FORM

PI-1274-DTC (New 09-15)



INSTRUCTIONS: This form must be completed by all district technology 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 STUDENT ASSESSMENT

PO BOX 7841

MADISON, WI 53707-7841

E-mail: osamail@dpi.wi.gov


or
Fax: (608) 266-8770







GENERAL INFORMATION







CESA No.

  


District No.

    


District Name

     





Name of District Technology Coordinator

     


Title

     





Email

     


Phone Area/No./Ext.

      Ext.     



Fax No. Area/No.

     








SIGNATURE







District Administrator’s Name Please print

     





District Administrator’s Signature



Date Signed Mo./Day/Yr.


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