Stipend Request Form For

Development of SWIVL Resource

February 1, 2018 through June 30, 2018

Building Name: / USD #
Co-teacher#1: / e-mail:
Co-teacher#1
Mailing Address:
Phone Number
Co-teacher #2: / e-mail:
Co-teacher #2
Mailing Address:
Phone Number
District Coach: / e-mail:
Co-teacher #2
Mailing Address:
Phone Number
Date of Session / Duration / Description
Date of Session / Duration / Description
Date of Session / Duration / Description
Date of Session / Duration / Description
Date of Session / Duration / Description
Date of Session / Duration / Description
Date of Session / Duration / Description
Date of Session / Duration / Description
Date of Session / Duration / Description

Stipend Amount Requested: ______($25 per hour for up to $200 total)

Co-teachers can complete up to 8 hours in planning and reflection outside the contract day.

Along with the SWIVL video, co-teachers and/or coaches must submit a copy of collaborative planning tool(s) or documentation:

  • Meeting minutes and action plan
  • Signed releases for any student and staff who are included in video
  • Self-Assessment: Are we really co-teachers
  • Co-teaching Differentiated Lesson plan
  • Reflection or narrative for the video

Co-teaching Coaches are also eligible to receive a stipend. Coaches’ participate in the planning session. Coaches are encouraged to then observe the planned lesson and complete an instructional observation form and a coaching post-conference. Use the SWIVL to record the coaching session and write a reflection to accompany video.

  • Submit the instructional observation form and coaching/feedback form
  • Upload video to SWIVL Pro account

By submitting this stipend request form, we verify that we have met for Co-planning purposes and have attached our completed plan of action, lesson planning tool, or collaborative planning tool(s). If lesson plan is created, it is suggested that the district coach take time to observe the lesson and provide a coaching session with the co-teaching team.

Signature of District Coach / Date
Signature of Co-teacher #1 / Date
Signature of Co-teacher #2 / Date

Please scan and email form and supporting documents to:

Shonda Anderson

SPECIAL NOTES:

After approval, you will be asked to contact Carol Koranda at UCP Sequin to provide your social security number for tax purposes.

If you would like to borrow the SWIVL Robot or need a SWIVL Pro account, please contact Shonda.