For Academic Services Use Only
Date Received
Date Responded

Intent to Apply

Please submit this form to the Academic Services Department at rior to developing a proposal. Note to Principals: You may e-mail this form, but it must be scanned with the campus principal’s signature.* Please do not alter the formatting of this form.

Applicant (School/Department) Information

Name of Contact: / School/Department:
Telephone: / E-mail:

Program Information

Name of Grant Opportunity: Houston Personalized Learning (PL) Pilot Program
Number to be served:
Grade levels to be served:
Summary of Proposed Project

Briefly outline the concept of your campus readiness and intent, and answer the first four questions outlined below. If your Letter of Intent is acceptable, you will be asked to develop a more in-depth proposal to participate in a pilot program, and to receive district services and resources toward a personalized learning program at your campus.

Letter of Intent Questions:

  1. What are some of the major issues that your students, teachers, and administrators face today? How would you currently describe your student’s level of college readiness and awareness?
  1. What type of exposure have your teachers and administrators had to personalized learning models?
  1. How do your teachers currently meet the individual needs of students? How is student data currently used to drive instruction?
  1. Why do you think personalized learning is the right strategy for your school? What are your initial ideas about a personalized learning model that would work particularly well in your school culture?

Questions to be addressed later in full proposal (you do not have to answer these questions now, they are strictly listed here as guided questions to think about):

  1. How might you create and sustain flexible learning environments (instructional models, use of time, use of space, mastery based progression)? What types of support would be provided to your teachers?
  1. Please outline a high level budget and identify possible sources of funding to support your PL model
  1. What limitations exist at your campus today to implement your proposed plan? (e.g. technology infrastructure, facilities, current professional development structure, other projects/grants, etc)
  1. What supports from the district level would be required to be successful?
  1. What outcomes would you expect to see for students and teachers if you successfully implement your PL plan?
  1. Describe your leadership team and your capacity to design, implement and sustain a personalized learning model at your campus.
  1. Who would be involved in your campus design team? Please provide a description of each member’s current position, and outlined roles and responsibilities on the design team.

Signatures
I certify that the information provided accurately represents the Proposed Project.
______
Program Contact’s Signature Date / I certify that I have reviewed the Intent to Apply and Summary of Proposed Project and agree with the proposed submission.
______
Principal/Department Manager’s Signature* Date
For Academic Services Use Only / Proceed with proposal development
Eligible to proceed with proposal development / Do not proceed with proposal development
Not eligible to proceed with proposal development / Reason(s):
______

Academic ServicesSignature Date

/ ______
Chief Academic OfficerSignature Date