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<p>Publisher Notice Office of Superintendent of Public Instruction Sexual Health Education Curriculum Review March 9-11, 2009 1 PUBLISHER SUBMISSION CHECKLIST **Please complete ONE checklist for each separate curriculum to be reviewed** Curriculum Name: ________________________________ Publisher: ___________________________________ Copyright Date: __________________________________ Representative Name: _______________________________________________________ Representative Email ________________________________________________________ Representative Phone:_____________________________ Grades Submitted for Review (circle all that apply): K 1 2 3 4 5 6 7 8 9 10 11 12 Contact information for purchase of curriculum: Phone: Website: Mailing Address: __________________________________________________________________________________ Please provide the following materials for EACH curriculum submitted for review:  One (1) Publisher Submission Checklist.  Two (2) complete copies of the complete curriculum to be reviewed.  One (1) Research Summary for the curriculum.  One (1) overview for the curriculum submitted for review. This may be submitted in hard copy format only, not to exceed 5 pages. Publisher Notice Office of Superintendent of Public Instruction Sexual Health Education Curriculum Review March 9-11, 2009 2 Publisher Representative Certification: I, _______________________________________________ (printed name), certify that the following statements are true and correct: The above materials have been submitted in accordance with the instructions outlined in the OSPI Publisher’s Notice for the Sexual Health Education Curriculum Review. The materials submitted are either published or in press and are available for purchase by April 2009. In addition, I understand that violation of the above statements will prevent the above curriculum from being considered as part of this Sexual Health Education Curriculum Review. I agree that I, and no other representatives from this publishing company, will not initiate contact with any members of the review committee during review week. I understand that any contact with reviewers during review week will be facilitated by an OSPI representative (contact information for review week provided below). Publisher Representative Signature ___________________________________________ Date_________________ Publisher Representative Contact Information: In the case that reviewers have questions during review week, OSPI will facilitate a conversation with the publisher representative and the reviewer. Please provide contact information for the individual in your company who would be best able to respond to reviewer questions regarding the curriculum during review week. Please be aware that the review hours run from 9:00am – 5:00pm Monday through Wednesday of the review week (March 9 -11, 2009). Publisher Representative Name: _______________________________________________ Contact Phone: _______________________________ Alternate Phone: ______________________________</p>
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