2026 Disseminator Application

Full Name

First NameLast Name
School Name
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
School Phone

Area CodePhone Number
School Fax

Area CodePhone Number
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone

Area CodePhone Number
E-mail
example@example.com
PROJECT TITLE (short, creative and to the point)
I Support This Application
Principal's Name

First NameLast Name
Are you interested in a degree program at NSU?
Are you interested in professional development at NSU?
II. DISSEMINATION INFORMATION
I am willing to (check if yes)
When do you use this idea? All year or During What Time?
What is the source of your idea and what adaptations have you made? (Please specify if it was originally an Innovative Teacher Grant or other Grant.)
Which teaching materials are developed and which will you develop in order to disseminate your idea? Please check all the appropriate option(s) below.

TEACHING TOOLS
Instructional Objectives
Lesson Plans
Materials/Equipment
Audiovisuals
Resource List
Student Work Sample(s)
Bibliography
Other - Specify
Please attach samples of all the materials you currently have developed. (up to 10 MB total)

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How has this program benefited your student’s academic achievement (i.e. test scores, attendance, attitudinal changes, student projects…)? Please provide an evaluation plan.
How might you help another teacher adapt this project?
What is the estimated cost for a teacher to adapt the project? (Please give both a low-end and high-end estimate.)
Have you ever presented this project? If so, where, when and for whom? How many people were in attendance?
Have you ever presented this project? If so, where, when and for whom? How many people were in attendance?
III. PROJECT PROFILE
Curriculum Area(s)
Quote
Title Of Project
The Project and the Virtual Project
The Students
Disseminator
Materials And Facilities
Resources
Outcome
More Information
Photograph (up to 10 MB)

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I understand that I must provide student outcome data and an impact statement related to my instructional goals each year.
Should be Empty:

II. DISSEMINATION INFORMATION

III. PROJECT PROFILE