LGM Local Affiliate Application for the Blended Learning Courses (2019-2020)

Local Affiliate Application for the Blended Learning Courses (2019-2020)
Thank you for your interest in the NEA Blended Learning Professional Learning Courses . The courses are a blended learning environment meant to support educators and education support professionals around instructional and classroom problems of practice. The Blended Learning program is a collaboration between the National Education Association and local affiliates.

The National Education Association (NEA) Center for Great Public Schools announces the availability of Teacher Quality grant funds (up to $3000 each ) for Local Affiliates to initiate and enhance capacity to provide effective professional learning opportunities using NEA’s new Blended Learning professional learning offerings to their local affiliate members.We are interested in working with locals that have expressed an interest in supporting the professional learning needs of our NEA 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 NEA Blended Learning site. Please complete all parts of this application. This application has seven sections and ask information about the following:

1 Applicant Information
2 Local Affiliate INformation
3 Interest in the NEA Blended Learning Courses
4 Identify your Local Lead Course Facilitator (LLCF)
5 State Affiliate Support
6 Funding Application for NEA Blended Learning Courses
7 Agreements

Application open date: ------

Application close date: extended to August 15

Decision by August 18
Applicant Information
Section 1: Please provide information regarding the individual submitting this application.
Name*

First NameLast Name
Email*
example@example.com
Today's Date*

MonthDayYear
Date
Cell Phone Number*

Area CodePhone Number
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?
Enter Amount
What is your affiliate's potential membership?
Enter Amount
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? *
Does your affiliate have the capacity to recruit 12-15 members to participate in the Blended Learning course(s)?*

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
I affirm that the local association president is supportive of this application and our participation in NEA's Blended Learning Course offerings for the 2019-2020 academic year.*

YesNoI don't know

Interest in the NEA Blended Learning Courses
Section 3: This section asks you to address the following questions to demonstrate your local affiliate’s interest and commitment to supporting the NEA Blended Learning Courses
Why do you believe the NEA Blended Learning Courses are important to your membership? Please be specific. *
What is the goal, vision, or change that you want as the focus of the NEA Blended Learning Courses? Please be specific*
How will the local affiliate support the implementation of the NEA Blended Learning Courses? Please be specific. *

Identify your Local Lead Course Facilitator (LLCF)
Section 4:

While the NEA Blended Learning courses have one local lead course facilitator per site , there should be a support network of affiliate staff members who can assist with the recruiting of a Local Lead Course Facilitator (LLCF) member that works with potential blended learning participants. We STRONGLY encourage diversity in identifying your local lead course facilitator.

The selected LLCF will attend an in-person blended learning training kick-off meeting (September 20-22, 2019) facilitated by NEA in downtown Chicago.
LLCF Name*

First NameLast Name
LLCF worksite position (teacher, ESP, etc)*
LLCF Email*
example@example.com
LLCF cell number*

Area CodePhone Number
Identify Local President or a Member of Elected Governance Supporting the Local Lead Course Facilitator and NEA Blended Learning Course implementation
Which member of elected governance will support the implementation of Blended Learning and the local lead course facilitator?
Name (member of elected governance)*

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

Area CodePhone Number
Current Level*

Pre-KElementary SchoolMiddle/ Jr. High SchoolHigh SchoolHigher EducationRetiredOther
Identify Local or State Affiliate Staff Member Supporting Implementation of Blended Learning
Which local or state affiliate staff member will support the implementation of Blended Learning and the local lead course facilitator?
Name*

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

Area CodePhone Number

State Affiliate Support
Section 5: A brief letter of support for your Local Affiliate's participation in the NEA Blended Learning coursework offerings is recommended from either your state president or executive director. Letters should be sent via e-mail to BOTH Luis-Gustavo Martinez at LGMartinez@nea.org and Ann Coffman at ACoffman@nea.org. Letters must be received no later than COB Thursday, August 15.
State Affiliate Association*
State Affiliate President*

First NameLast Name
State Affiliate Executive Director*

First NameLast Name
State IPD Director
State IPD Director email
Do the people named above support the participation in NEA's Blended Learning Course offerings for your affiliate?*

Yes, they will e-mail a letter to Luis-Gustavo Martinez and Ann Coffman as described aboveNoI don't know

Funding Application for NEA Blended Learning Courses
Section 6: The purpose of this funding is to work with Local Affiliates offering NEA’s comprehensive “blended learning” programs that will provide high quality professional learning to members in a combination of in-person and online learning platforms.

Funding should be used for operation of the program including, but not limited to, Local-Lead Course Facilitator stipends, meeting expenses, and/or mileage for participants (e.g. rural affiliates).
Please provide a brief overview of your Local or State Association’s plan to provide effective professional learning opportunities using NEA’s Blended Learning course offerings to your local affiliate members. *
Please indicate the Blended Learning Course(s) you’re interested in implementing at your site. Note: *Indicates courses appropriate for both teachers and Education Support Professionals (ESP)*

I Can Do It (ICDI) - Classroom ManagementBully and Sexual Harassment Prevention *Working with Pre-Service Teachers (Cooperating Teacher Training)Lesbian, Gay, Bisexual Transgender, Queer (LGBTQ) Safety Bias and Issues in Schools *English Language Learners (ELLs) *
Please provide an overview of your Blended Learning program’s goals and objectives, expected outcomes, and an evaluation plan for each program proposed.*
Provide a line item budget for the proposed program. Your request must total less than $3000. Identify any additional support (monetary or in-kind) from other sources, including that provided by your school/district college/ university. The NEA suggests that your budget be as cost-efficient as possible. Please ensure that all items are directly related to your proposed work, as your budget will be assessed by how realistic, clear, and frugal it is.*

Agreements
Section 7:
I understand that all applications must be received no later than Thursday, August 15 , 2019 COB.

I understand and agree.
We understand that submitting this application is not a guarantee that our local affiliate will be accepted as an NEA Blended Learning site.

We understand and agree.
We understand that if accepted to participate in the NEA Blended Learning Courses, we are agreeing to share our plan, collaborate, dedicate resources to implement the plan, and provide reports on the team's progress on our plan to Luís-Gustavo Martínez or the designated staff member in the department of Teacher Quality at the NEA.

We understand and agree.
Please feel free to contact Luís-Gustavo Martínez at LGMartinez@nea.org / (202)822-7396 or Ann Coffman at ACoffman@nea.org if you have any questions or need additional information.
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Local Affiliate Application for the Blended Learning Courses (2019-2020)

Applicant Information

Local Affiliate Information

Interest in the NEA Blended Learning Courses

Identify your Local Lead Course Facilitator (LLCF)

State Affiliate Support

Funding Application for NEA Blended Learning Courses

Agreements