Urban Science Education Leadership Academystatic.nsta.org/pdfs/2012USELAcademyApplication.pdf · Education Leadership Academy. Districts wishing to participate must: - Commit to the

Urban Science Education Leadership Academy

Application

Submit by May 28, 2012

This academy is delivered in partnership between the Urban Science Education Leaders (USEL)

and the National Science Teachers Association (NSTA)

The Urban Science Education Leaders (USEL) in collaboration with the National Science Teachers

Association (NSTA) is providing urban school districts an opportunity to attend an Urban Science

Education Leadership Academy.

Districts wishing to participate must:

- Commit to the participation in the Urban Science Education Leadership Academy in Austin,

Texas, July 15, 2012 – July 20, 2012.

- Elementary/Middle teachers, accompanied by a principal and district science supervisor.

- Commit to the participation in electronic professional development sessions during the school

year.

- Commit to provide the teachers with the necessary materials and support for the 2012-2013.

- Commit to phasing in research-based practices, with a focus on inquiry, in elementary/middle

science education.

- Submit the district application which must include a letter of commitment from the Principal

and Regional/Area superintendant or his/her designee.

Application Process

Step one: Complete the District Commitment Form. (Electronic or scan signatures are acceptable )

Step two: Complete the District Application Form.

Step three: Complete Individual Application Forms.

Step four: Collect all documents and submit by Monday May 28, 2012 via email attachment to

Damaries Blondonville ([email protected]) or fax to 703-522-1698 or 703-243-3952

Step five: Your application will be reviewed by a committee and selection for participation will be based

on the following criteria:

1. The application, commitment letter and individual team member applications are

complete.

2. The application clearly shows how academy attendance helps your school

initiate/continue a strategic plan for elementary/middle science education.

All Fees must be paid by May 28, 2012 by check, money order, or school district PO

Academy fees:

- Academy cost is $1, 200.00 per person. Fees include registration, materials, up to 5 nights lodging, and

breakfast and lunch on full program days.

- Academy cost is $6,000 per 5 member team. Fees include registration, materials, up to 5 nights lodging,

and breakfast and lunch on full program days.

*Each participant is responsible for his/her own transportation cost and all evening meals.

mailto:[email protected]

dblondonville

Typewritten Text

District Commitment


Delivered in partnership between the Urban Science Education Leaders (USEL)


The following letter of commitment must be signed by the regional superintendent/designee, school principal

and the individual(s) responsible for science curriculum in the district. Signatures should include individuals who

hold decision-making power for the teachers who will attend.

District Commitment

The _____________________________________________ commits to attend the Urban (District Name) Science Education Leadership Academy in Austin, Texas July 15, 2012- July 20, 2012. Further, we commit to team member participation in online follow up sessions during the school year following summer academies. We believe that the Urban Science Education Leadership Academy fits into our strategic planning process and will assist us with implementing an improved science education program. Please commit to the above by signing in the appropriate space below. All regional superintendents involved (as well as other key stakeholders) should sign this document.

___________________________________________ ________________________

Signature (Regional Superintendent/Central Office Date

___________________________________________ ________________________

Signature (District Science Coordinator/Designee) Date

___________________________________________ ________________________

Signature (Principal) Date

* Applications will not be considered complete until all signatures are complete.

District Application – Page 1


Delivered in partnership between the Urban Science Education Leaders (USEL)


Application Form

District Name _________________________________________________________________________

City ____________________________________________ State_________________________________

District Contact______________________________________ Job Title___________________________

Contact Information for District Contact:

Email Address_________________________________________________________________________

Work Phone #(____) ___________________________ Secondary Phone #(____) _________________

Mailing Address ______________________________________________________________________

_____________________________________________________________________________________

District Demographics

Number students enrolled ________ elementary _________ middle ________ high school

Number of schools ________ elementary _________ middle ________ high school

What percentage of the student population is eligible to receive free and reduced lunch? ____________

Percentage race/ethnicity of student population

African-American

Hispanic

Native American

Asian

Caucasian

Other

In what urban area is your district located? _________________________________________________

What is the population of this urban area? __________________________________________________


1. How will your district’s attendance in the Urban Science Education Leadership Academy help fulfill

your strategic plan for elementary/middle science education improvement in your district?

2. What are your goals for elementary/middle science education improvement?

3. Please indentify your districts current science programs. Please list all instructional materials used

by K-8 classroom teachers (please include textbooks, kits, trades books, electronic resources,

support materials).


4. Name your team members and explain why these members were chosen.

Name Position in district Justification for placing this person on your team.

1st team member (district

science coordinator)

2nd team member

(principal)

3rd team member

(teacher)

4th team member

(teacher)

5th team member

(teacher)

Other:

Other:

District Science Coordinator Application – Page 1

District Science Coordinator/Designee Application


Name ______________________________________ Position ________________________________

School _______________________________________________________________________________

District ______________________________________________________________________________

Contact Information:

Email Address _________________________________________________________________________

(Please provide an email address that you monitor year round)

Alternate email address ________________________________________________________________

Work Phone # (____) ___________________________ Secondary Phone # (____) _________________

Mailing Address (available to you throughout the year)

____________________________________________________________________________________

____________________________________________________________________________________

Describe your formal education, degrees attained, dates granted and your major area of study.

Describe the experience you have had that qualifies you to be a leader for elementary/middle science

improvement in your school/district.

Why are you interested in elementary/middle science education improvement?

District Science Coordinator Application – Page 2

Name ________________________________________________________________________________

What Professional Development opportunities have been offered to K-8 science teachers in your district

this past year?

What Assessment Model is your district currently using to measure student achievement in science?

What grade levels take the formal state assessment in science?

If selected to attend, I fully understand that I am responsible for my own transportation to and from the academy and all evening meals during the academy. Team Members Name: _________________________________________________________________ Team Members Signature: ______________________________________________________________ Date: ________________________________________________________________________________


Principal Application – Page 1

Principal Application


Name ______________________________________ Position ________________________________

School _______________________________________________________________________________

District ______________________________________________________________________________


Email Address _______________________________________________________________________

(please provide an email address that you monitor year round)


Work Phone #(____) ___________________________ Secondary Phone #(____) _________________


____________________________________________________________________________________

____________________________________________________________________________________





Principal Application – Page 2

Name _______________________________________________________________________________

What science curriculum materials do you use in your school? Please name the publisher and the units

of study? (Please give the publishers used across the district at the elementary/middle grade levels.)

What PD opportunities have been offered to your science teachers this past year?


If selected to attend, I fully understand that I am responsible for my own transportation to and from the academy and all evening meals during the academy. Team Members Name: _________________________________________________________________ Team Members Signature: ______________________________________________________________ Date: ________________________________________________________________________________

Principals Signature (electronic or scanned)


Teacher #1 Application – Page 1

Teacher #1 Application


Name ______________________________________ Position ________________________________

School _______________________________________________________________________________

District ______________________________________________________________________________


Email Address _________________________________________________________________________





____________________________________________________________________________________

____________________________________________________________________________________





Teacher # 1 Application – Page 2

Name ______________________________________________________________________________

What science curriculum materials do you use in your classroom? Please name the publisher and the

units of study? (If you are a district representative, give the publishers used across the district at the

elementary/middle grade levels.)



If selected to attend, I fully understand that I am responsible for my own transportation to and from the Academy and all evening meals during the Academy. Team Members Name: _________________________________________________________________ Team Members Signature: ______________________________________________________________ Date: ________________________________________________________________________________



Name _______________________________________________________________________________

If you are a teacher, please have your principal complete the following section

of the application.

Why did you choose this teacher to participate in the Urban Science Education Leadership Academy?

How do you believe his/her participation will impact your school?

By signing this document, I am committing to attend the 2012 Urban Science Education Leadership

Academy with my team in Austin, Texas if selected, and participate in scheduled electronic professional

development with other teams during the 2012-2013 school year.

Participants Signature (electronic or scanned)






Name ______________________________________ Position ________________________________

School _______________________________________________________________________________

District ______________________________________________________________________________


Email Address ________________________________________________________________________





____________________________________________________________________________________

____________________________________________________________________________________






Name ______________________________________________________________________________

What science curriculum materials do you use in your classroom? Please name the publisher and the

units of study? (If you are a district representative, give the publishers used across the district at the

elementary/middle grade levels.)






Name _______________________________________________________________________________


of the application.












Name ______________________________________ Position ________________________________

School _______________________________________________________________________________

District ______________________________________________________________________________


Email Address _________________________________________________________________________





____________________________________________________________________________________

____________________________________________________________________________________






Name ________________________________________________________________________________

What science curriculum materials do you use in your classroom/district? Please name the publisher

and the units of study? (If you are a district representative, give the publishers used across the district at

the elementary/middle grade levels.)






Name ________________________________________________________________________________


of the application.









Documents

Urban Science Education Leadership Academystatic.nsta.org/pdfs/2012USELAcademyApplication.pdf · Education Leadership Academy. Districts wishing to participate must: - Commit to the