Applicant Summary Sheet Spring 2018 ACN …...27. If instructor is supervised by a certified teacher, describe supervision and reporting structures of the proposed course. (150 words)

Applicant Summary Sheet

Spring 2018 ACN Provider Proposals

Name of Course ProviderOrganization

Organization Website

Organization Address

Years in Existence

Number of Employees

1. Course Provider Organization Information*

Name

Title

Phone

Email

2. Organization's ACN Point of Contact Information*

3. Organization’s Governing Body*

4. Will new employees be hired to implement approved courses?*

5. If yes, how many and in what capacity? (50 words)

6. Which best describes your organization?*

Private Postsecondary educational organization

RI Non-profit Organization

Rhode Island Local Education Agency/District or School

Department of Labor and Training Approved Partner

1

7. List title(s) of proposed course offering(s)*

Name

Title

Address

Phone: Landline

Phone: Cell

Email

8. Primary contact and program lead*

Organization Overview


9. Provider Vision for Course Offerings (250 words): Describe your vision and rationale for applying to be a course provider.Explain why you are focusing on the specific course offering(s) in your proposal and how your course offering(s) will help betterensure Rhode Island students graduate college- and career-ready.

*

10. Provider Background (250 words): Describe your organization’s background, history, and how you arepoised/qualified to offer this course including previous experiences in providing courses such as these. Listany current, relevant accreditation your organization holds.

*

2

11. Supports for students requiring Special Education Services: The organization has at least theminimum supports in place as required by respective laws governing the organization to support studentsrequiring special education services.

*

Yes

No

12. Supports for students requiring Special Education Services (150 words): Describe theservices provided by the organization to support students requiring special education services in achievingsuccess in the proposed courses including the minimum supports required by law and additional servicesprovided. Note: Priority will be given to applications demonstrating strong supports for these students.

*

13. Supports for students requiring English Language Learner Services: The organization has at leastthe minimum supports in place as required by respective laws governing the organization to supportstudents identified as English Language Learners.

*

Yes

No

14. Supports for students requiring English Language Learner Services (150 words): Describe theservices provided by the organization to support students identified as English Language Learners inachieving success in the proposed courses including the minimum supports required by law and additionalservices provided. Note: Priority will be given to applications demonstrating strong supports for these students.

*

15. Statewide Recruitment (150 words): Describe your organization's networks, communities, andpartners that will be accessed to recruit students to ensure enrollment in proposed courses.

*

16. Safety and Liability Protection: Does your organization have the insurance, policies and proceduresin place to ensure student safety and liability protection?

*

Yes.

No.

3

Proposed course offering(s)


Course Title

Existing Course Code (ifapplicable)

Location and StreetAddress

Prerequisites

Maximum Enrollment

SCED Code

17. Proposed course offering(s)*

18. How will the proposed course be instructed?

Face-to-Face

Online / Virtual

19. When is the proposed course scheduled to meet?

Weekdays (Monday-Friday) before 2 pm *only if this is an established section also serving non-ACN students*

Weekdays (Monday-Friday) after 2 pm

Weekends (Saturday-Sunday)

20. Course Description for Catalog (150 words)

4

21. Course Curriculum and Experience. Describe the curriculum and delivery of the course. Note: Youwill be asked to describe specific activities and assessments for the standards to which the course isaligned in the Standards Appendix. (150 words)

22. Course Outcomes. Describe a student's outcomes from successful completion and the potential post-secondary application of those outcomes.

23. Course and credentials opportunities (indicate all that apply). Note: Provider applicants must also fill outStandards Survey to indicate the ways in which courses align to state-adopted standards.

*

Middle School Credit

High School Credit

Industry Credential

College Credit

Course Budget Appendix (upload template)

Provider Name *

Course Name/Course ID *

Course Budget Appendix (upload template) *

No file selectedChoose File

Submit

24. Budget Notes: Please provide any additional information regarding your proposed course budget.*

25. Overview of Instructor Qualifications:*

College faculty teaching a course for college credit

Teacher with a teaching certificate

Instructor supervised by a teacher with a teaching certificate

26. What type of certification does the teacher have?*

College Faculty (teaching a course for College Credit)

Middle Grades English Teacher

Middle Grades English Teacher Elementary Extension*

5

Middle Grades English Teacher Secondary Extension*

Middle Grades Mathematics Teacher

Middle Grades Mathematics Teacher Elementary Extension *

Middle Grades Mathematics Teacher Secondary Extension *

Middle Grades Science Teacher

Middle Grades Science Teacher Elementary Extension *

Middle Grades Science Teacher Secondary Extension *

Middle Grades Social Studies Teacher

Middle Grades Social Studies Teacher Elementary Extension*

Middle Grades Social Studies Teacher Secondary Extension*

Middle Grades Special Education Teacher*

Middle Grades Bilingual Dual Language Teacher*

Middle Grades English as a Second Language Teacher*

Secondary Grades Agriculture Teacher

Secondary Grades Biology Teacher

Secondary Grades Business Education

Secondary Grades Career & Technical Education Teacher

Secondary Grades Chemistry Teacher

Secondary Grades English Teacher

Secondary Grades General Science Teacher

Secondary Grades Mathematics Teacher

Secondary Grades Physics Teacher

Secondary Grades Social Studies Teacher

Secondary Grades Special Education Teacher*

Secondary Grades Bilingual Dual Language Teacher*

Secondary Grades ESL Teacher*

All Grades Adapted Physical Education Teacher*

All Grades Art Teacher

All Grades Bilingual and Dual Language Education Teacher*

All Grades Dance Teacher

All Grades ESL Education Teacher*

All Grades Family and Consumer Science Teacher

All Grades Health Teacher

All Grades Library Media Teacher

All Grades Music Teacher

All Grades Physical Education Teacher

6

All Grades School Nurse Teacher

All Grades Technology Education Teacher

All Grades Theatre Teacher

All Grades World Language Teacher

All Grades Special Education- Deaf and Hard of Hearing

All Grades Special Education- Visually Impaired

All Grades Special Education- Severe Intellectual Disability

27. If instructor is supervised by a certified teacher, describe supervision and reporting structures of theproposed course. (150 words)

Attach resume / CV of Teacher of Record

Provider Name *


Attach resume / CV of Teacher of Record *


Submit

28. Are you applying to offer another course?*

Yes

No

Copy of page: Proposed course offering(s)


7

Course Title



Prerequisites

Maximum Enrollment

SCED Code



Face-to-Face

Online / Virtual







8



*


High School Credit

Industry Credential

College Credit


Provider Name *




Submit















9





































10





Provider Name *




Submit


Yes

No



Course Title



Prerequisites

Maximum Enrollment

SCED Code


11


Face-to-Face

Online / Virtual









*


High School Credit

Industry Credential

College Credit

12


Provider Name *




Submit

























13






























14


Provider Name *




Submit


Yes

No



Course Title



Prerequisites

Maximum Enrollment

SCED Code



Face-to-Face

Online / Virtual

15









*


High School Credit

Industry Credential

College Credit

16


Provider Name *




Submit

























17






























18


Provider Name *




Submit


Yes

No



Course Title



Prerequisites

Maximum Enrollment

SCED Code



Face-to-Face

Online / Virtual

19









*


High School Credit

Industry Credential

College Credit

20


Provider Name *




Submit

























21






























22


Provider Name *




Submit

76. Would you like to add additional courses?*

Assurances


77. CERTIFICATION STATEMENT

By submitting this form I, as a representative of my organization, have read and understood allrequirements and specifications of the Request for Proposal (RFP). By its submission of this proposal andauthorized signature below, Applicant certifies that:

(1) The information contained in this proposal is accurate.

(2) Applicant complies with each of the mandatory requirements listed in the RFP and will meet or exceedthe requirements specified therein.

(3) Applicant accepts the procedures, evaluation criteria, mandatory terms and conditions, and all otheradministrative requirements set forth in this RFP.

(4) Applicant’s proposal is valid for at least one year from the date of signature below.

*

I have read and understood all requirements and specifications

I have not read and understood all requirements and specifications

23

Name

Phone

Email

78. Person completing the application:

24

Documents

Applicant Summary Sheet Spring 2018 ACN …...27. If instructor is supervised by a certified teacher, describe supervision and reporting structures of the proposed course. (150 words)