District PD Application

Complete this form as your electronic submission for the district professional development application. Reference the District K-3 Teacher Reading Professional Development document for additional guidance. ||Application Questions|| Please submit to the following form: https://app.smartsheet.com/b/form/aae2a9d019b446cfbe8b408b6eef1f6c

Form Date Field

SECTION C: COVER PAGE

This section is not scored, but must be included.

Contact Information

LEP/BOCES name*

Check here before inputting official name: https://www.cde.state.co.us/datapipeline/org_orgcodes

LEP/Boces code*

Check here before inputting 4-digit code: https://www.cde.state.co.us/datapipeline/org_orgcodes

Main Contact*

Contact person for the review submission

Mailing Address*

Webpage*

Telephone*

Email*

Professional Development Program Submission Overview

Professional Development Title*

Publication Year*

Alignment to Teacher Standards*

After reviewing the teaching standards (see Appendix E), check the box(es) below for each standard addressed within the professional development. NOTE: Professional development submitted for review for the evidence-based training in teaching reading category must select all the boxes below and complete all the sections of the Phase 2 Worksheet: Alignment to Colorado Teacher Standards.

Select or enter value

Audience*

Select or enter value

Other

If selected other above for audience, please specify:

SECTION D: READING DEVELOPMENT THEORY

Please save as PDF and name the file in the following format: districtname_EBTT_SecD_readingtheory Ensure this document is uploaded in the "File Attachments" section at the end of this form.

SECTION E: PROFESSIONAL DEVELOPMENT MODEL & DELIVERY

Please save as PDF and name the file in the following format: districtname_EBTT_SecE_modeldelivery Ensure this document is uploaded in the "File Attachments" section at the end of this form.

Contact hours

How many contact hours are needed to successfully complete this professional development?

SECTION F: MINIMUM STATE REQUIREMENTS

Please save as PDF and name the file in the following format: districtname_EBTT_SecF_minimum Ensure this document is uploaded in the "File Attachments" section at the end of this form.

SECTION G: THEORY OF ACTION & DOCUMENTATION OF EFFECTIVENESS

Please save as PDF and name the file in the following format: districtname_EBTT_SecG_actioneff Ensure this document is uploaded in the "File Attachments" section at the end of this form.

SECTION H: ONGOING SUPPORT & TRAINING STAFF

Please save as PDF and name the file in the following format: districtname_EBTT_SecH_trainers Ensure this document is uploaded in the "File Attachments" section at the end of this form.

SECTION I: PHASE 2 WORKSHEET - Alignment to Teacher Standards

Please save as PDF and name the file in the following format: districtname _EBTT_SecI_worksheet Ensure this document is uploaded in the "File Attachments" section at the end of this form.

SECTION J: Usability

Please save as PDF and name the file in the following format: districtname _EBTT_SecJ_usability Ensure this document is uploaded in the "File Attachments" section at the end of this form.

SECTION K: District Review & Agreement of Completion

There are two documents to upload for this section: the district completed rubric and the signed agreement of completion. RUBRIC: Please save in EXCEL format and name the file in the following format: districtname_EBTT_SecK_rubric Ensure this document is uploaded in the "File Attachments" section at the end of this form. AGREEMENT OF COMPLETION: Please save as PDF and name the file in the following format: districtname_EBTT_2020_signature Ensure this document is uploaded in the "File Attachments" section at the end of this form.

Application Attachments

File Attachments*

Ensure the following documents have been completed as requested within the application and uploaded here prior to submitting. 1. SECTION D: districtname_EBTT_SecD_readingtheory 2. SECTION E: districtname_EBTT_SecE_modeldelivery 3. SECTION F: districname_EBTT_SecF_minimum 4. SECTION G: districtname_EBTT_SecG_actioneff 5. SECTION H: districtname_EBTT_SecH_trainers 6. SECTION I: Phase 2 Worksheet - districtname _EBTT_SecI_worksheet 7. SECTION J: districtname _EBTT_SecJ_usability 8. SECTION K: Scored Rubric - districtname_EBTT_SecK_rubric 9. SECTION K: Agreement of Completion - districtname_EBTT_2020_signature 10. TRAINING MATERIAL: districtname_EBTT_2020_trainingmaterials All files (except for the scored rubric) above need to include: • PDF format • A footer with the following: District name, date of submission, and page numbers The rubric aligned with section K should be submitted in the original EXCEL format. If the supporting materials for your application are too large to be attached to the smartsheet form, please reach out to Marisa Calzadillas at Calzadillas_m@cde.state.co.us.

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