Education Fund Disseminator Application

Please download, fill out, and sign the Disseminator Agreement Form. After you have signed the agreement, please use the file upload form below to return the document to us. In order to expedite payment of funds if your application is selected, we require your signature on a conditional agreement form, a direct deposit form, copy of a voided check, and submission of a W9 in your name (not your school). This form does not guarantee that you will be selected, and your application will not be considered without submitting these forms with your application.

Click here to download the Agreement Form

Upload your completed and signed Agreement Form*

You will also need to download and fill out an IRS W-9 Form. After you have completed the form, please use the file upload form below to return the document to us.

Click here to download an IRS W-9 Form

Upload your completed and signed W-9 Form

Please download and fill out the ACH form for payments. After you have completed the form, please use the file upload form below to return the document to us.

Click here to download the ACH Form

Upload your completed and signed ACH Form

Upload your voided check

Name*

First NameLast Name

Mobile Number*

M-DCPS Employee Number*

M-DCPS Email Address*

If you are a Charter School teacher, please enter your email.

Personal Email*

Full Name of School*

School Location Number*

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Project Title*

Short, creative, and descriptive

List all grade levels for which your workshop project can be implemented.*

What is the project subject area? *

Can this project be adapted to other subject area(s)?*

YesNo

Please list the other subject areas.*

Can this project be adapted to other grade levels?*

YesNo

Please list the other grade levels.*

What is the total number of students that you teach? *

Which grade level(s) do you teach? *

Which subject area(s) do you teach?*

What is the source of your idea? (Please specify if it was original idea, Innovator Grant, or other grant project).*

How has this project benefited your students' academic achievement? (ie. test scores, attendance, attitude changes, student projects, etc.). *

Enter the estimated cost for a teacher to adapt the project. (Must not exceed $400.)*

The questions below create a consistent format within which you may create a profile of your project. If you are selected, this ONE-page profile will be used as the primary copy in showcasing your idea in next year’s Ideas with IMPACT catalog.

Curriculum Area(s): List one or two areas of major focus*

Describe your project clearly and concisely. Start with a one-sentence description of the purpose of the project. Elaborate with examples of what students do and learn. Provide at least one detailed example of a classroom activity.*

Please list 3-5 full Florida standards. Ex: MAFS.4.G.1.1 points, lines, line segments, rays, angles right, acute, obtuse, and perpendicular and parallel lines. Identify these in two dimensional figures*

Describe how many students participate in the project, including grade or age, level of achievement, and how often they meet. *

Describe your teaching experience; mention awards and/or grants. *

How long have you used the project? *

Does this project require assistants, paraprofessionals, or volunteers?*

YesNo

Materials required for this project: Describe the setup (space, equipment) and materials needed (books, supplies). *

Resources needed: Include such resources as field trips, use of school media center, public library, the Internet, contributions and loans from parents or institutions, and guest speakers.*

Overall Value: Write a few sentences that sell your project. Describe the project’s best features, innovative aspects and contributions to student achievement (cognitive and affective). Explain why teachers would want to adapt it for their classes.*

What can teachers expect to see in your workshop? List 5 things teachers will learn in your Expo workshop about how to teach your ideas to their students. *

Idea Expo workshop Disseminators receive stipends of $750 for the time they spend on the following activities: (Please check “Yes” to confirm you're willing to undertake the following activities.)

Make an instructional booklet on how to implement your project*

YesNo

Present one or more workshops on your project at the Idea EXPO*

YesNo

Please upload a color photograph suitable for reproduction that projects a visual statement of your project. Ideal images include a close-up photo of 1-2 students working on a project, smiling, and looking at the camera. Multiple images may be uploaded.

Upload M-DCPS Headshot*

jpg, jpeg, png, gif, tiff

Please upload photos of your students working on your workshop project. *

Please upload any additional photos related to your workshop project.

Signature*

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Disseminator Application

Agreement Form & W-9

Curriculum Idea Profile

Photographs