SchoolSafety.gov State Information Sharing Tool Collaboration Application

The Federal School Safety Clearinghouse (Clearinghouse) recently launched a new functionality within SchoolSafety.gov geared toward sharing state-specific school safety information and resources. This page serves as your state’s or territory’s application/expression of interest in collaborating with the Clearinghouse on further developing and building out content for this new State Information Sharing Tool.

Please note that this application is meant to be completed on behalf of your state or territory as a whole. As such, the Clearinghouse recommends designating a single office or organization to complete this application and to serve as the point of contact (POC) to lead collaboration efforts with the Clearinghouse. This POC should be the primary office or organization who is leading and/or coordinating school safety efforts across your state or territory.

Once your state or territory has identified the appropriate POC, please fill out the information below. After your application has been received and processed, you will receive a formal acknowledgment along with information about scheduling a formal Collaboration Kick-Off Meeting.

Any questions regarding this application can be directed to SchoolSafety@hq.dhs.gov. Thank you in advance for you interest in this effort!

Question Title

* 1. Please identify the U.S. state or territory you are completing this application on behalf of.

Question Title

* 2. Please list the name, title, organization, and contact information for the individual completing this application.

Name

Title

Organization

Email Address

Phone Number

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* 3. Please list the office or organization that will serve as the designated POC for your state or territory.

Question Title

* 4. Please list the appropriate contact information for this designated POC.

Office/Organization

Individual POC(s)

Email Address(es)

Phone Number(s)

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* 5. By checking the box below, you are expressing interest in collaborating on the State Information Sharing Tool on behalf of your state or territory.

I Confirm

Pursuant to 5 U.S.C. § 552a(e)(3), this Privacy Act Statement serves to inform you of why DHS is requesting the information on this form.
Authority: 5 U.S.C. 301; 44 U.S.C. 3101.
Purpose: DHS is requesting this information in order to process, review, and verify an application for access to the Safety and Emergency Planning for Schools, Homeland Security Information Network (HSIN) Community of Interest (COI). This Survey Monkey application was provided either through direct email or through the “Information Sharing Community” link.
Routine Uses: The information requested on this form may be shared externally as a “routine use” with other named contributors to this interagency website (DHS, DOJ, ED & HHS) to assist DHS in providing instructions for accessing the secure HSIN COI through the use of the “Information Sharing Community” link. A complete list of the routine uses can be found in the system of records notice associated with this form, “DHS/ALL-002 DHS Mailing and Other Lists System.” The Department’s full list of system of records notices can be found on the Department's website at http://www.dhs.gov/system-records-notices-sorns.
Disclosure: Providing basic contact information is strictly voluntary. However, failure to provide this information may result in being denied access to the Safety and Emergency Planning for Schools HSIN COI.