Stevensville School District
3125F
School District
Liaison
Telephone
Date of first contact by homeless individual, guardian, or representative __________________________________________________________________
Homeless Student’s Name _______
Describe the issue(s) in question _________________________________________________________________________________________
School District Contact
(Superintendent/Principal)
Date (within 7 business days)
Telephone
Resolution at Liaison/School District Level (describe below) or Forwarded to OPI Homeless Coordinator [please contact at (406) 444-2036]
Date (within 15 business days)
Resolution at OPI Homeless Coordinator Level (describe below) or Forwarded to Superintendent of Public Instruction
Describe Resolution Results _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Homeless Coordinator Signature
This form must be filed with:
Heather Denny, Homeless Coordinator
Office of Public Instruction PO Box 202501
Helena, MT 59620-2501
11/14/2017
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