2020 Safe Schools and Emergency Preparedness Planning Certification Form

School year
County
School corporation number
School corporation name *
Primary School Safety Specialist *

First Name Last Name
Primary School Safety Specialist Email *
example@example.com
Superintendent printed name *

First Name Last Name
Superintendent Email *
example@example.com
Superintendent signature

Use your mouse to sign your name Clear
Date

Month Day Year
Should be Empty: