2013-14 LaSIP PROFESSIONAL DEVELOPMENT PROJECTS

Appendix E:  Proposal Submission Forms Provided
Form 1	Notice of Intent	
Form 2	Proposal Cover Page	
Form 3	Project Abstract	
Form 4	Project Progression Timeline	
Form 5	Measurable Objectives Worksheets 	
Form 6	Curriculum Vitae	
Form 7	Current and Pending Support	
Form 8	Memorandum of Agreement Among Partners	
Form 9	Cooperative Planning Efforts 	

2013-14 LaSIP PROFESSIONAL DEVELOPMENT PROJECTS
NOTICE OF INTENT 

Name of Institution (Include Branch/Campus and School or Division):	

Address (Include Department):

	

Principal Investigator(s):                                                                                                                     

Phone:  ( )                                                    Fax:  (     )              
                               
E-mail:                                               

Tentative Title of Project:	

This non-binding Notice of Intent should include the following information:

(1) The primary focus, including discipline/subject matter; 

(2) The districts or regions to be served; (Place an * by the high-need LEAs)

(3) The intended grade levels; and 

4)  The proposed outcomes.

[This information will be used to ensure adequate preparation for the review of LaSIP PD proposals, including engagement of consultants with appropriate expertise. Applicants may modify the information provided above in part or whole as proposal development continues.]

2013-14 LaSIP PROFESSIONAL DEVELOPMENT PROJECTS

COVER PAGE

Indicate content focus (Science, LIGO, ELA/Literacy, or  Mathematics):

Grade Level(s) Targeted:  

Number of Targeted Participants: 

School Districts To Be Served:
Indicate high-need districts with an asterisk *
	
 Name(s) of Submitting Institution(s) of Higher Education (Include Branch/Campus/Other Components):
	
Address of Institution of Higher Education (Dept/Unit, Street Address/P.O. Box Number, City, State, Zip Code):
	
Title of Proposed Project:	
Funds being requested for each funding cycle:	
July 1, 2013-September 30, 2013     	October 1, 2013 – June 30, 2014     	
Matching funds from partners:     	
IHE:
     	High-need LEA(s):
     	Other:
     	
The signatories certify that the institution and the proposed project are in compliance with all applicable Federal and State laws and regulations.	

Name/Title/Institution (if different from the primary institution listed)	
Dept./Telephone No.
Email Address	
	Signature	
Principal Investigator 

	
	
Co-Principal Investigator

	
	
Campus Head or 
Authorized
Institutional Representative	

Dean, College of 
Education 
			
Dean, College of  
Arts and Sciences
 			
Authorized 
Fiscal Agent

2013-14 LaSIP PROFESSIONAL DEVELOPMENT PROJECTS
PROJECT ABSTRACT

Name of Institution (Include Branch/Campus):	

College/Department:

Principal Investigator:                                                                                                                     

Phone:   (            )                                                                Fax:  (         )          
                                 
E-mail:                                                                           	

Title of Project:	
Abstract (maximum of 500 words): Address each item below in the order given:
(1) A brief paragraph describing the overall vision of the project
(2) The project’s specific content focus and measurable objectives
(3) The high-need LEA(s) and targeted schools/districts involved
(4) The participants for which the project is designed ( i.e., classroom teachers, special ed teachers,   
     paraprofessionals, and/or administrators)
(5) The number of days & contact hours during the summers & AY
(6) The number of participants & content coaches
(7) The targeted grade levels
(8) The primary activities and proposed outcomes
_____________________________________________________________________________

	

2013-14 LaSIP PROFESSIONAL DEVELOPMENT PROJECTS

Time line	Contact Hours	Action/Activities	Measureable Objective for each activity	Staff Responsible	
April 2011	6 hours	First meeting with participants; overview of project; pre/test; discussion of individual student data; participant data		All staff present and responsible	
June 2011	6 hours/5 days	Professional development; content focus, assessment, leadership		J. Jackson, content; S. Smith, assessment; R. Fletcher, leadership/educational technology	

					

					

					
					
PROJECT PROGRESSION TIMELINE OF ACTIVITIES TABLE
(Please delete the sample provided below)

2013-14 LaSIP PROFESSIONAL DEVELOPMENT PROJECTS
Measureable Objectives Worksheet (1)

Aligned with the first LaSIP goal stated below, design at least two measureable objectives which answer each of the following five questions:
(1) 	Who is involved? 
(2) 	What is the desired outcome? 
(3) 	How will progress be measured?
(4) 	When will the outcome occur? 
(5) 	What is the level of proficiency? 

Combine the five answers to form a sentence for your measureable objective.  Use the checklist provided on page ___ to ensure the objectives contain all necessary components. This page may be duplicated if additional objectives are desired. 

LaSIP Goal 1:  	Increase student achievement on State high-stakes testing.

Who:
What:
How: 
When:
Proficiency Level:
Goal 1, Objective 2:  

(Form 4- 2010-11 LaSIP PD, Revised August 2009)
(Duplicate this sheet for each LaSIP goal and the project designed measurable objectives)

2013-14 LaSIP PROFESSIONALDEVELOPMENT PROJECTS

Measureable Objectives Worksheet (2)

Aligned with the first LaSIP goal stated below, design at least two measureable objectives which answer each of the following five questions: 
(1) 	Who is involved? 
(2) 	What is the desired outcome? 
(3) 	How will progress be measured?
(4) 	When will the outcome occur? 
(5) 	What is the level of proficiency? 

Refer to page ______ for a detailed explanation of each question.  Finally, combine the five answers to form a sentence for your measureable objective.  Use the checklist provided on page 44 to ensure the objectives contain all necessary components. This page may be duplicated if additional objectives are desired. 

LaSIP Goal 2:  	Plan effective PD based on the high-need LEA(s)/schools’ data-driven needs and developed using research-based PD strategies that will take place in summer institutes, during the academic year (AY), and/or through on-line or web-based assignments and job-embedded activities.

Who:
What:
How: 
When:
Proficiency Level:
Goal 2, Objective 1:  

Who:
What:
How: 
When:
Proficiency Level:
Goal 2, Objective 2:  

(Form 4- 2010-11 LaSIP PD, Revised August 2009)
(Duplicate this sheet for each LaSIP goal and the project designed measurable objectives)

2013-14 LaSIP PROFESSIONAL DEVELOPMENT PROJECTS

Measureable Objectives Worksheet (3)

Aligned with the first LaSIP goal stated below, design at least two measureable objectives which answer each of the following five questions:
(1) 	Who is involved? 
(2) 	What is the desired outcome? 
(3) 	How will progress be measured?
(4) 	When will the outcome occur? 
(5) 	What is the level of proficiency? 

Finally, combine the five answers to form a sentence for your measureable objective.  Use the checklist on provided on page 44 to ensure the objectives contain all necessary components. This page may be duplicated if additional objectives are desired. 

LaSIP Goal 3:  	Increase leadership capacity and pedagogical skills for target schools through school/district buy-in, school-based implementation, and mentoring during the AY.  

Who:
What:
How: 
When:
Proficiency Level:
Goal 3, Objective 1:  

Who:
What:
How: 
When:
Proficiency Level:
Goal 3, Objective 2:  

(Form 4- 2010-11 LaSIP PD, Revised August 2009)
(Duplicate this sheet for each LaSIP goal and the project designed measurable objectives)

2013-14 LaSIP PROFESSIONAL DEVELOPMENT PROJECTS

Measureable Objectives Worksheet (continued)

Measurable objectives should indicate rigor and relevance and must include objective     
data that will determine that the objective was met. Objectives should be clearly identify the following: 

Who is involved:  The people whose behaviors, knowledge, and/or skills are to be changed or enhanced as a result of the program.

What the desired outcomes are:  The intended behavior, knowledge, and/or skill changes that should result from the program or activities.

How progress is measured:  What tools or devices (surveys, tests, data from other sources) will be used to measure the expected changes? Remember to ensure that the project has the resources/capacity (time, staff, funding, etc.) to perform the measurements.

Proficiency level:  Identify the criteria that will determine success of the project (i.e., total mastery 100% or 80% of the time).

When outcomes will occur:  Identify the time frame for success.  (Writing Objectives: A Guide,    
 NCMS Department of Education Services)

     Objectives Checklist:

	Objectives contain all elements
	Who 
	What
	How 
	When
	Proficiency Level

		Redundancy has been eliminated
	Objectives relate to needs assessment findings
	Objectives can really be measured
	Capacity to perform measurement is present
	Instrument or data source has been identified

	Shows how assessment:
	Assesses what each component does
	Assess outcome
	Should not have separate assessment unless you expect different outcomes of different groups (i.e., all students vs. students receiving specific supplemental services)

2013-14 LaSIP PROFESSIONAL DEVELOPMENT PROJECTS
CURRICULUM VITAE

Name
	
Current Position Title

Project Position Title

EDUCATION (Begin with baccalaureate or other initial professional education and include postdoctoral training.	

INSTITUTION AND LOCATION	
DEGREE	
YEAR
CONFERRED	
FIELD OF STUDY	

	

	
                                                                                 
RESEARCH AND PROFESSIONAL EXPERIENCE:  DO NOT EXCEED TWO PAGES. Begin with present position, list in reverse chronological order previous relevant employment, experience, and honors.

2013-14 LaSIP PROFESSIONAL DEVELOPMENT PROJECTS
CURRENT AND PENDING SUPPORT

List all State and federal funding support for each IHE faculty member during the funding cycle. Duplicate this form for each IHE faculty member, and use additional sheets as necessary. 

NAME OF Faculty:                                    

Status of Support:      Current      Pending       Submission Planned in Near Future     

Proposal Title (or Semester Teaching Support):     

Source of Support:     

Award Amount (or Monthly Teaching Rate): $         Period Covered:     

Location of Activity:      

Person-Months or % of Effort Committed to the Project:        Cal Yr        AY        Summer

Status of Support:      Current       Pending        Submission Planned in Near Future     

Proposal Title(or Semester Teaching Support):     

Source of Support:     

Award Amount (or Monthly Teaching Rate): $          Period Covered:     

Location of Activity:     

Person-Months or % of Effort Committed to the Project:        Cal Yr         AY        Summer

Status of Support:     Current        Pending           Submission Planned in Near Future     

Proposal Title (or Semester Teaching Support):     

Source of Support:     

Award Amount (or Monthly Teaching Rate):         Period Covered     

Location of Activity:     

Person-Months or % of Effort Committed to the Project:        Cal Yr         AY          Summer

	

2013-14 LaSIP PROFESSIONAL DEVELOPMENT PROJECTS
Memorandum Of Agreement Among Partners

(Name of Sponsoring Institution or Institutions)

                                                                                                  	
                                        
(Project Title)

                                        
(Principal Investigator)	
                                        
(Co- Principal  Investigator)
		
This cooperative agreement reflects the overall commitment as well as the specific responsibilities and the roles of each of the partners listed below. This MOA documents the actual working partners who are responsible for contributing to the writing of the proposal, collecting and reporting data, and for the day to day success of the project.  
Type of Partner	Name of Active Partner	Title 	IHE or District & School	Signature	
Teacher Preparation Program
(Required)					
Dept./School of Arts & Sciences
(Required)					
High-need Local Education Agency/Agencies   
(LEA – Required)					
Additional Targeted Partners 

				

Memorandum of Agreement Among Partners (cont.)
Sponsoring Institution:

Principal Investigator:
	
Type of Partner	Name	Title	IHE or District & School	Signature	
Additional Partners 

				
Additional Partners 

				
Additional Partners

				

2013-14 LaSIP PROFESSIONAL DEVELOPMENT PROJECTS

Cooperative Planning Efforts

Describe the process of collaboration between the high-need LEA(s), other targeted schools, and the IHE(s) in determining the needs of the LEA(s) in planning and writing this proposal.  The statement should be endorsed and dated by an official from each participating institution. In addition, Letters of Support must be included in the appendices of the proposal.

1.                                                             ____________
      Typed Name, Title, Organization		Signature			Date

2.                                                             ____________
      Typed Name, Title, Organization		Signature			Date

3.                                                             ____________
      Typed Name, Title, Organization		Signature			Date

4.                                                             ____________
      Typed Name, Title, Organization		Signature			Date

5.                                                             ____________
      Typed Name, Title, Organization		Signature			Date

6.                                                             ____________
      Typed Name, Title, Organization		Signature			Date

7.                                                             ____________
      Typed Name, Title, Organization		Signature			Date

8.                                                             ____________
      Typed Name, Title, Organization		Signature			Date

9.                                                             ____________
      Typed Name, Title, Organization		Signature			Date

10.                                                             ___________
      Typed Name, Title, Organization		Signature			Date

  

2013-14 LaSIP PROFESSIONAL DEVELOPMENT PROJECTS

APPENDIX F: Stipend Options 
You must choose either Option A or B for use in your project, and document your choice in your proposal.  Should your proposal be funded, you must provide this information to your participants within a Participant Agreement or Project Syllabus.  For either option, you must insert the number of days and hours for your project and the hourly stipend rate, and provide a list of your project deliverables.  Projects must provide a total stipend hourly rate at a minimum of $20 per hour and a maximum of $30 per hour.    LaSIP encourages the use of Option B.  

Option A  
Attendance is expected for all ____ days (total of ____ hours) of the project.  Participants will receive a maximum fee of $25 per hour for attendance participation at the summer institute and academic year workshops. Payment will be made only on approval of and documentation from the principal investigator, (Name of authorized person), according to the LaSIP Attendance Policy. Participant will be paid only for the actual hours he/she participates in the professional development program.  If the Participant has unexcused absences for more than 15% of the scheduled program hours, Participant may be dropped from the program at the discretion of the principal investigator and will not be eligible to receive instructional materials from the project.  Any instructional materials already received must be returned to the principal investigator. LaSIP Attendance Policy regarding unexcused absences will be enforced.

Option B 
Attendance is expected for all ____ days (total of ____ hours) of the project.  Participant will receive a $20 per hour for attendance participation at the summer institute.  Upon completion of the required activities/deliverables (designed by PI) and days of attendance during the AY, participant will receive the remaining $5 for each full hour attended during the summer project.  This will in effect raise the stipend rate to $25 per hour attended and will only apply if participant meets required obligations.  Stipends for the AY workshops will be $25 per hour for attendance.  Payment will be made only on approval of and documentation from the principal investigator, (Name of authorized person), according to the LaSIP Attendance Policy. Each participant must complete the assigned deliverables during the AY.  If the participant has unexcused absences for more than 15% of the scheduled program hours, the participant may be dropped from the program at the discretion of the principal investigator and will not be eligible to receive either instructional materials from the project or the additional $5 per hour for attendance participation at the summer institute.  In this event, any instructional materials already received must be returned to the principal investigator. LaSIP Attendance Policy regarding unexcused absences will be enforced.