Professional Development Screening Application

Professional Development Screening Application

Completing this form is step one of a three step process. Step one is the screening process. Step 2 is reference and background check. Step 3 is confirmation of details of the project. NTICE Foundation Board will review applications that have completed all three steps. Reminder, NTICE does not fund 100% of expenses of professional development.
Name of School or School District*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
School Director Name:*

First NameLast Name
School Director Email:*
example@example.com
School Contact Phone Number:*
Please enter a valid phone number.
Name of person responsible for professional development:*

First NameLast Name
Number of staff members participating in professional development:*
Minimum 5
Upload a description of professional development answering these questions (less than 1000 words):

1. What is the need in the school that generated the selection of the professional development (PD).

2. What anticipated changes will the PD accomplish?

3. What data is driving this decision?

4. How long is it anticipated for implementation or application of PD?

5. Who will benefit from PD?
Upload description of professional development:*

Cancelof
Upload 2-3 picture of the school:*

Cancelof
Anticipated Date of Needed Funds:*

YearMonthDay
Applications are reviewed semi annually: July and December with recipients receiving notice in September and in February.
Total amount of professional development:*
What other funds are being used to fund the professional development event and the amounts?
1.   Type a label   $
2.   Type a label   $
3.   Type a label   $
Requested NTICE Grant amount:*
$7,000 - $50,000
Itemized expenses of professional development that are needed and the amounts:
1.   Type a label   $
2.   Type a label   $
3.   Type a label   $
4.   Type a label   $
Reference Checks Information
Staff Member Participant
Name:*

First NameLast Name
Email:*
example@example.com
Professional Development Administrator/Coordinator
Name:*

First NameLast Name
Email:*
example@example.com
Phone Number:*
Please enter a valid phone number.
School Board Member
Name:*

First NameLast Name
Email:*
example@example.com
Business Manager
Name:*

First NameLast Name
Email:*
example@example.com
**Contact will be made with the administrator(s) and the professional development coordinator.
Should be Empty:

Professional Development Screening Application

Reference Checks Information