c4Reading Apprenticeship Eligibility Application

c4

Reading Apprenticeship

Eligibility Application

Thank you for your interest in the EIR federal grant, Accelerating Literacy through Self-Regulation, Collaboration and Persistence.

To determine eligibility, please complete this form as soon as possible. Please answer the following questions to the best of your knowledge. If you are not able to answer a question, please skip that question.

All of the information you provide on this application is confidential and will be used for the purpose of the study only. If you have questions about this form or the study please contact the EIR Program Coordinator, Bill Loyd, at wloyd@wested.org.

Interest*

Please indicate your interest in pursuing eligibility in the EIR federal grant.

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Would you please let us know why you are not interested?

Person filling out this form's first and last name*

Person filling out this form's title*

Person filling out this form's email*

Person filling out this form's phone number*

District information

District name*

District County*

Is your district identified as low-wealth?*

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How many high schools in this district will participate?*

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High school information

High school name*

Type*

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Principal's name*

if different from the person filling out this application, otherwise enter "Same"

Principal's phone number*

if different from the person filling out this application, otherwise enter "Same"

Principal's email*

if different from the person filling out this application, otherwise enter "Same"

Grade levels at this school*

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Approximate number of teachers who you anticipate will teach at least one section of mainstream, 9th or 10th grade ELA, History, and Science*

Approximate number of other teachers you would like to send to PD (on a space permitting basis determined by WestEd)*

Additional high schools

If applicable. If no additional high schools, please scroll to the bottom of this form. Note that answers will not be recorded until you click the "submit" button.

High school name

Type

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Principal's name

if different from the person filling out this application, otherwise enter "Same"

Principal's phone number

if different from the person filling out this application, otherwise enter "Same"

Principal's email

if different from the person filling out this application, otherwise enter "Same"

Grade levels at this school

Select or enter value

Approximate number of teachers who you anticipate will teach at least one section of mainstream, 9th or 10th grade ELA, History, and Science

Approximate number of other teachers you would like to send to PD (on a space permitting basis determined by WestEd)

High school name

Type

Select or enter value

Principal's name

if different from the person filling out this application, otherwise enter "Same"

Principal's phone number

if different from the person filling out this application, otherwise enter "Same"

Principal's email

if different from the person filling out this application, otherwise enter "Same"

Grade levels at this school

Select or enter value

Approximate number of teachers who you anticipate will teach at least one section of mainstream, 9th or 10th grade ELA, History, and Science

Approximate number of other teachers you would like to send to PD (on a space permitting basis determined by WestEd)

High school name

Type

Select or enter value

Principal's name

if different from the person filling out this application, otherwise enter "Same"

Principal's phone number

if different from the person filling out this application, otherwise enter "Same"

Principal's email

if different from the person filling out this application, otherwise enter "Same"

Grade levels at this school

Select or enter value

Approximate number of teachers who you anticipate will teach at least one section of mainstream, 9th or 10th grade ELA, History, and Science

Approximate number of other teachers you would like to send to PD (on a space permitting basis determined by WestEd)

High school name

Type

Select or enter value

Principal's name

if different from the person filling out this application, otherwise enter "Same"

Principal's phone

if different from the person filling out this application, otherwise enter "Same"

Principal's email

if different from the person filling out this application, otherwise enter "Same"

Grade levels at this school

Select or enter value

Approximate number of teachers who you anticipate will teach at least one section of mainstream, 9th or 10th grade ELA, History, and Science

Approximate number of other teachers you would like to send to PD (on a space permitting basis determined by WestEd)

High school name

High school type

Select or enter value

Principal's name

if different from the person filling out this application, otherwise enter "Same"

Principal's phone

if different from the person filling out this application, otherwise enter "Same"

Principal's email

if different from the person filling out this application, otherwise enter "Same"

Grade levels at this school

Select or enter value

Approximate number of teachers who you anticipate will teach at least one section of mainstream, 9th or 10th grade ELA, History, and Science

Approximate number of other teachers you would like to send to PD (on a space permitting basis determined by WestEd)

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