(PLC) for Administrators Application
Western Region Co- Teaching Professional Learning Community (PLC) for Administrators Application Please fill out this application and return to Paula Schmitt, Educational Consultant, PaTTAN Pittsburgh, at [email protected] by the close of business on September 30, 2013. Name of Applicant: ___________________________________________________________________________________________________________ Email Address:
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Title/Role:
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Name of District:
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If School Administrator, Name of Building: ______________________________________________________________________________________ Office Mailing Address: ______________________________________________________________________________________________________
Please address the following items, providing insight into your interest in participating in the Western Region Co-Teaching PLC for Administrators: 1. Describe the extent to which co-teaching is currently implemented in your school or across your district. Respond to each of the subsections: Who is doing co-teaching?
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When is co-teaching occurring? ______________________________________________________________________________________________ Where is co-teaching taking place? ___________________________________________________________________________________________ How is co-teaching being implemented? _______________________________________________________________________________________ 2. What readiness skills does your school/district need to effectively implement co-teaching?
3. What do you think is currently working well given your school /district’s co-teaching efforts (if applicable)?
4. What do you think may be barriers associated with your school/district’s co-teaching efforts?
5. Describe your school/district’s efforts to provide personnel training and technical assistance on co-teaching.
6. Which of the following projects has your school district participated in: MPL (Membership, Participation and Learning)
IELS (Inclusive Education Leadership Series)
IMFTS (Include Me From The Start)
7. Explain why you would like to participate in this Co-Teaching PLC for Administrators and what you hope to gain from this experience.
Statement of Commitment: I have read the expected commitments associated with the Co-Teaching PLC and verify that it is my intent to fully participate. I also have the approval of my immediate supervisor to engage in this PLC. Name: _______________________________________________________ Title: _________________________________________ Date: _______________
___________________________________________________________________________________________________________
Title/Role:
___________________________________________________________________________________________________________
Name of District:
___________________________________________________________________________________________________________
If School Administrator, Name of Building: ______________________________________________________________________________________ Office Mailing Address: ______________________________________________________________________________________________________
Please address the following items, providing insight into your interest in participating in the Western Region Co-Teaching PLC for Administrators: 1. Describe the extent to which co-teaching is currently implemented in your school or across your district. Respond to each of the subsections: Who is doing co-teaching?
_________________________________________________________________________________________________
When is co-teaching occurring? ______________________________________________________________________________________________ Where is co-teaching taking place? ___________________________________________________________________________________________ How is co-teaching being implemented? _______________________________________________________________________________________ 2. What readiness skills does your school/district need to effectively implement co-teaching?
3. What do you think is currently working well given your school /district’s co-teaching efforts (if applicable)?
4. What do you think may be barriers associated with your school/district’s co-teaching efforts?
5. Describe your school/district’s efforts to provide personnel training and technical assistance on co-teaching.
6. Which of the following projects has your school district participated in: MPL (Membership, Participation and Learning)
IELS (Inclusive Education Leadership Series)
IMFTS (Include Me From The Start)
7. Explain why you would like to participate in this Co-Teaching PLC for Administrators and what you hope to gain from this experience.
Statement of Commitment: I have read the expected commitments associated with the Co-Teaching PLC and verify that it is my intent to fully participate. I also have the approval of my immediate supervisor to engage in this PLC. Name: _______________________________________________________ Title: _________________________________________ Date: _______________
