Wisconsin Department of Public Instruction INSTRUCTIONS: This form must be completed by all district assessment

DISTRICT ASSESSMENT COORDINATOR (DAC)
UPDATE FORM
PI-1274-DAC (Rev. 08-11)
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. Fax No. Area/No.

            Ext.           

Mailing Address

     

Shipping Address

     

City State ZIP Code

              

SIGNATURE
District Administrator’s Name Please print

     

District Administrator’s Signature Date Signed