DRAFT Local Affiliate Application for the NEA Early Career Learning Labs (2018-2019)

Local Affiliate Application for the NEA Early Career Learning Labs (2019-2020)
Thank you for your interest in the NEA Early Career Learning Labs (ECLL). The ECLL is a blended learning environment meant to support early career educators (ECEs) around instructional and classroom problems of practice. The ECLL program is a collaboration between the National Education Association and local affiliates.

The NEA is interested in working with locals that have expressed an interest in supporting the professional learning needs of our early career educator members. Participating locals should have a commitment from the local association's elected officers and Executive Board to support this program. Completing this application does not guarantee that your local will be accepted as an Early Career Learning Lab site.

Please complete all parts of this application. This application has several sections and ask information about the following: the applicant, affiliate, affiliate’s interest in ECLL, members supporting your affiliate’s ECLL, and your state affiliate support.

Before submitting an application for the NEA Early Career Learning Labs, please see the following link: http://bit.ly/ECLLAppResources

Application close date: Friday, May 17, 2019
Applicant Information
Section 1: Please provide information regarding the individual submitting this application.
Name*

First NameLast Name
Cell Phone Number*

Area CodePhone Number
Email*
example@example.com
Enter the Name of your Local Affiliate*
(Official Name - no abbreviations, i.e. United Teachers of Los Angeles)
Current Role in your Local Affiliate*
What is your position in your district (classroom teacher, paraeducator, department chair, etc)? *
Local Affiliate Information
Section 2: Please provide the following information about the local affiliate
What is your affiliate's total membership?
example@example.com
What is your affiliate's total membership? *
What is your affiliate's potential membership?
example@example.com
What is your affiliate's potential membership? *
YesNoI don't know
What is your best estimate for the number of members with less than five years experience in your affiliate? *
What is your best estimate for the number of members with less than two years experience in your affiliate? *
Should program funding be dispersed through your state affiliate, or directly dispersed to the local affiliate? *
YesNoI don't know
YesNo
Local Affiliate President*

First NameLast Name
Local Affiliate President's Email*
example@example.com
Local Affiliate Executive Director*

First NameLast Name
Local Affiliate Executive Director's Email*
example@example.com
Local Affiliate Treasurer*

First NameLast Name
Local Affiliate Treasurer's Email*
example@example.com
Local Affiliate Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
YesNoI don't know
Interest in the NEA Early Career Learning Labs
Section 3: This section asks you to address the following questions to demonstrate your local affiliate’s interest and commitment to supporting the NEA Early Career Learning Labs. Please be as detailed as possible in your responses.
Why do you believe the NEA Early Career Learning Labs is important to your membership? Please be specific.*
What is the goal, vision, or change that you want as the focus of the NEA Early Career Learning Labs? Please be specific. *
How will the local affiliate support the implementation of the NEA Early Career Learning Labs? Please be specific.*
This past year, several sites recruited educators of color to retain and engage them as educators. Is your local affiliate interested in being considered to exclusively recruit educators of color? If so, please be specific in how and why you would engage educators of color. (This question is optional.)
Identify your Local Coordinator
Section 4: While the NEA Early Career Learning Labs will have one local coordinator, there should be a team supporting the development and engagement of early career educators, that includes a member of governance, affiliate staff member, an individual who can help with recruiting ECEs, a member that works with early career educators (a mentor or a coach), and an early career educator. The primary role of the Local Coordinator is to identify and support ECEs throughout their learning cycles. The Local Coordinator serves as the primary liaison to NEA and the NEA will provide training to this Local Coordinator. For more information on identifying a local coordinator, please see our resources.
Local Coordinator*

First NameLast Name
Local Coordinator worksite position (teacher, ESP, etc) *
Local Coordinator's Email*
example@example.com
Local Coordinator's cell number*

Area CodePhone Number
Identify Local President or a Member of Elected Governance Supporting the Local Coordinator and ECLL implementation
Which member of elected governance will assist the implementation of ECLL and the local coordinator?
Name (member of elected governance)*

First NameLast Name
Role (example: President, Officer) *
Email*
example@example.com
Cell Phone Number*

Area CodePhone Number
What is the main subject this member of elected governance teach or support?*
Pre-KElementary SchoolMiddle/ Jr. High SchoolHigh SchoolHigher EducationRetiredOther
Identify Local or State Affiliate Staff Member Supporting Implementation of ECLL
Which local or state affiliate staff member will support the implementation of ECLL and the local coordinator? This person will serve as the staff contact for this ECLL site, and could be an uni-serv director, local or state affiliate staff.
Name*

First NameLast Name
Role (example: UniServ) *
Email*
example@example.com
Cell Phone Number*

Area CodePhone Number
Virtual Coach

The Virtual Coach will be responsible for guiding and supporting small groups of Early Career Educators (ECEs) in unpacking and learning around their problems-of-practice. A Virtual Coach is expected to work 4-6 hours a week and with at least 12 teachers at a time. If you have a member of your local that you would like to recommend as a virtual coach, please indicate here or e-mail Ambereen Khan-Baker (akhanbaker@nea.org) with those names. If not, and if your site is selected, we will identify a virtual coach for your site. Please note: all virtual coaches must complete a separate application process.
Recommendations for Virtual Coaches
State Affiliate Support
Section 5: A brief letter of support for your team’s participation in the Early Career Learning Labs is recommended from either your state president or executive director. Letters should be sent via e-mail to BOTH Ambereen Khan Baker at akhanbaker@nea.org and Ann Coffman at ACoffman@nea.org. Letters must be received no later than COB May 17.
State Affiliate Association*
State Affiliate President*

First NameLast Name
State Affiliate Executive Director*

First NameLast Name
Yes, they will e-mail a letter to Ambereen Khan-Baker and Ann Coffman as described aboveNoI don't know
Agreements

Section 6
I understand and agree.
We understand and agree.
We understand and agree.
By clicking the submit button below, I cerity that all of the information provided by me on this application is true and complete, and I understand that if any false information or misrepresentations are discovered, that our application may be rejected.
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Local Affiliate Application for the NEA Early Career Learning Labs (2019-2020)

Applicant Information

Local Affiliate Information

Interest in the NEA Early Career Learning Labs

Identify your Local Coordinator

Identify Local President or a Member of Elected Governance Supporting the Local Coordinator and ECLL implementation

Identify Local or State Affiliate Staff Member Supporting Implementation of ECLL

Virtual Coach

State Affiliate Support

Agreements