Application and Questions for Student Local Engagement Exemplar Prize
Please complete the application below and email this application and any additional documents to by 5:00 P.M., March 23, 2016. Only applicants from eligible counties (Central Coast, Central Valley, and Inland Empire) may apply. For application process instructions, please see the Local Engagement Exemplar Prize Overview document.
1. Date:
2. Submitted by (Name, Title/Role):
3. District:
4. District Mailing Address:
5. District Representative Name andPhone Number:
6. District Representative Email:
7. If this is a joint application, name of partner Parent/Student Community Organization:
8. Brief description of district student populations (strengths, needs, unique considerations, etc.):
9. Brief (1-2 paragraph) responses to the following questions. The Local Engagement Exemplar Prize shines a spotlight on innovative and uplifting engagement practices that support academic achievement and overall wellbeing for students (please consider referencing the student engagement example practices shared in the Local Engagement Exemplar Prize Overview).
a)What steps has your district taken to develop meaningful and sustainable relationships with English language learners, foster youth, and low-income students as an effective foundation for planning and implementation and advancing a culture of engagement and partnership?
b)What contributions has your district asked English language learners, foster youth, and low-income students to make during the planning, implementation, and ongoing improvement process?
c)What types of sustainable strategies that support systemic or culture changes forengagement were most effective in terms of increasing active contributions from English language learners, foster youth, and low-income students?
d)How have contributions from English language learners, foster youth, and low-income students informed the design or delivery of LCAP services in your district?
10. Briefly describe one accomplishment you are most proud of that will improve student outcomes through a culture of change that would not have been possible without active student engagement:
11. Provide a one-paragraph summary of your district’s strategies that have most effectively engagedEnglish language learners, foster youth, and low-income students:
12. Please attach any supporting evidence to the application that highlights or demonstratesaspects or key learnings from your district’s student engagement process that impactcritical areas such as:
- Leveraging relationships/partnership with students, parents, and community to support deeper engagement practices
- Building internal capacity for site level leaders and teachers to support deeper engagement
- Creating sustainable strategies that supportsystemic or culture changes for meaningful engagement
- Shared decision-making/leadership
13. If applicable, briefly describe any pending litigation with any community partner organization to which the district is a party, including the disclosure of any outstanding judgment. If applicable, please explain how litigation may materially impact the district’s ability to serve as a model for innovative and uplifting engagement practices.
14.Contact information for at least two parent/student community organizations that were meaningful partners in the district’s engagement process.
Community organization #1
Name:
Address:
Contact Name:
Contact Phone:
Contact Email:
Community organization #2
Name:
Address:
Contact Name:
Contact Phone:
Contact Email:
14. Check the following confirmation statements:
Yes / No / StatementI am at least 18 years of age.
The superintendent or superintendent designee of the district has approved this application (signature required below).
I understand that the prize money will be awarded directly to the district and must be used to support continued district engagement practices that advance health for all.
I understand excerpts of this application may be posted on the TCE website and other public distribution channels.
I understand the two prize winning districts must be willing to share more detailed examples of engagement practices which will be posted publicly and deliver a presentation at a mutually-determined public forum.
I understand that pending litigation between the district and any community partner organization(s) will be taken into consideration in determining whether the district meets the qualifications for the prize
15. Signatures:
______
ApplicantDate
______
Superintendent /Superintendent Designee Date
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