Campus Instructional Leadership Team

HIGH SCHOOL

Application Form

2010 – 2011

Name: ______DISD Employee ID Number: ______

Campus:______Campus Org. #:______

Assignment:______Learning Community: ______

I am applying for the position of:

____CILT Content Area Representative (Indicate content area: ______)

____Enrichment Representative (health, technology applications, art, music, theatre, dance, Languages Other than English or physical education)

____ESL Representative

____Special Education CILT Representative

____Career and Technical Education Representative

____Student Support Team (SST) Chairperson(school counselor recommended)

List previous and current teaching experience:

Comments:

APPLICANT:

I confirm that I have received, read and understand the roles/responsibilities for the appropriate Campus Instructional Leadership Team position. My signature verifies that, if chosen, I agree to attend the Dallas Achieves XX: Summer Institute for Campus Leaders, districtwide and area professional development and satisfy all other requirements, duties and responsibilities as stipulated for this position. I also understand that if I fail to complete the job requirements as outlined, my extra-duty pay will be prorated or forfeited, according to circumstances determined by the principal.

Applicant’s Signature:Date:

(Duplicate as needed)

HIGH SCHOOL

Campus Instructional Leadership Team

MEMORANDUM OF AGREEMENT

2010 – 2011

CILT Member: ______DISD Employee ID Number: ______

Campus: ______Campus Org. #:______

Assignment: ______Learning Community: ______

Email Address: ______First time CILT member? Yes_____No____

CILT Member:

I confirm that I have received, read and understand the Roles/Responsibilities of the CILT position. My signature verifies that I agree to attend the Dallas Achieves XX: Summer Institute for Campus Leaders, districtwide and Learning Community training, provide technical assistance, and satisfy all other requirements, duties and responsibilities as stipulated for this position. I also understand that if I fail to complete the job requirements as outlined, that the extra-duty pay will be prorated according to the number of days worked or forfeited, according to circumstances determined by the principal. NOTE: All CILT appointments are contingent upon approval of principal (current principal or newly assigned 2010 – 2011 principal, if applicable). Compensation is contingent on budget approval.

CILT Member’s Signature ______Date ______

PRINCIPAL:

I certify that ______meets the qualifications for the CILT position and is hereby selected for the specific CILT position as checked below:

____Department Chairperson/Content Area Representative (Content area: ______)

____Enrichment Representative (health, technology applications, art, music, theatre, dance, Languages Other than English or physical education)

____ESL Representative

____Career and Technical Education Representative (only at designated high schools - see page 5 of the information packet)

____Special Education Representative

____Student Support Team (SST) Chairperson

Principal’s Signature ______Date ______

Keep originals of the Memorandum of Agreement forms on file at the campus. Make copies of the completed, signed Memorandum of Agreement forms to send with the completed original Campus Summary sheet to the Learning Community Coordinator by April 19, 2010.

(Duplicate as needed)

CILT Members Summer Mailing List

Please print or type all information.SCHOOL: ______

Name / Summer Mailing Address / Summer Contact Information
Street Address: Apt. #
City: State: Zip Code: / Telephone number:
Email Address:
Street Address: Apt. #
City: State: Zip Code: / Telephone number:
Email Address:
Street Address: Apt. #
City: State: Zip Code: / Telephone number:
Email Address:
Street Address: Apt. #
City: State: Zip Code: / Telephone number:
Email Address:
Street Address: Apt. #
City: State: Zip Code: / Telephone number:
Email Address:
Street Address: Apt. #
City: State: Zip Code: / Telephone number:
Email Address:
Street Address: Apt. #
City: State: Zip Code: / Telephone number:
Email Address:
Street Address: Apt. #
City: State: Zip Code: / Telephone number:
Email Address:
Street Address: Apt. #
City: State: Zip Code: / Telephone number:
Email Address:
Principal’s Name: / Street Address: Apt. #
City: State: Zip Code: / Telephone number:
Email Address:

Please send a copy of the CILT Summer Mailing List to the Learning Community Coordinator by April 19, 2010. Information will be used to notify CILT members of any changes or updates in summer training information.

(Duplicate as needed)

Campus Instructional Leadership Team (CILT)

2010-2011 HIGH SCHOOL Campus Summary

Campus: Principal:______

Please print or type the following information:

Department Chairperson/ Content Area Position
(9 positions) / Department Chairperson/Content Area Representative’s Name
(List only one person's name per slot.) / DISD Employee
ID Number
(Please ensure accuracy of ID number for payment purposes.) / Roles/
Responsibilities
Distributed (√) / Memorandum of
Agreement Form Signed (√)
Reading/Language Arts
Mathematics
Science
Social Studies
ESL
Enrichment
CTE
Special Education* - CILT
Student Support Team (SST) Chairperson/Counselor

NOTE: Only the designated number of CILT members will receive the training stipend and the CILT stipend from the CILT budget. If additional campus-paid CILT members are identified, they must be listed on the next page.

______

Principal’s SignatureDateLearning Community Executive Director’s Signature Date

Submit COPIES of all signed Memorandum of Agreement forms, completed ORIGINAL Campus Summary, and CILT Summer Address form to Learning Community Office Coordinator. Due April 19, 2010

Campus Instructional Leadership Team (CILT) 2010-2011 Campus Summary

for CAMPUS-PAID Members

Campus: Principal:______

There are a specific number of designated CILT members for each campus whose training supplemental pay for attending the August 3 days of training/planning and annual stipend is paid for from designated campus CILT funds or central funds. If a principal selects additional CILT members above and beyond the designated number, the campus must pay for the three days of training/planning in August and the annual stipend of $1,000 from campus funds. The principal’s and Learning Community Executive Director’s signature at the bottom of this page verify that these additional members are approved, that adequate campus funds are available, and that these additional members will be paid for through campus funds other that the designated CILT campus funds. Note: A budget transfer must be completed for all campus-paid CILT members after July 1, 2010.

Please print or type the following information:

Name / DISD ID # / Program/Content Area Represented

______

Principal’s Signature DateLearning Community Executive Director’s Signature Date

Submit COPIES of all signed Memorandum of Agreement forms, completed ORIGINAL Campus Summary and CILT Summer Address form to Learning Community Office Coordinator. DUE April 19, 2010.