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