LEADERSHIP INTERN PROGRAM
2017 APPLICATION /
Candidate Information
Name: (first) (middle) (last) / Date:
Current Position: / Home Address:
School: / Home City/State/Zip:
School District: / Home Phone:
Work Phone: / CellPhone:
Work E-mail: / Home E-mail:
PREFERRED E-MAIL: Work Home This is the address that will be used by AWSP for ALL correspondence with you.
Years in Education: / Level: / Elem / Middle / High / Other
Applicant for: Principal Program: Elementary Mid Level High School / Program Administrator Superintendent
Intern Site (if known): / Mentor Principal/Supervisor (if known):
College/University Attending: / College/University Program Director/Advisor:
Campus Location:
University Information
Education Administration Program Approval
The applicant:Has completed the necessary prerequisites/requirements to enter the intern program.
Has the support of the Program Director(s) for admission to the intern program. Agrees to develop and implement a written plan structuring the release time experiences in cooperation with the site mentor.
Program Director: Date:
Signature
School District Information
Recommending Administrator:Title:
Location:Phone:
District Approval
District agrees to provide the state-awarded release time for the namedintern during the 2017–18 school year, which will not be transferrable by the district to other interns.
Actual daily replacement substitute teacher cost for the 2017–18 school year (including salary and
Benefits): $. (The reimbursement amount to districts will be based on a daily substitute allocation rate established by the Legislature.)
District agrees to assign a qualified site mentor to the intern.
Finance Officer (or designee):
Signature Print
Superintendent (or designee):
Signature Print
Date:
Incomplete or Late Applications Will Not be Considered
Memorandum066-16M
Form SPI 1651 (17/18)Page 1November 2016
Application Requirements
- Complete the Application Form (page 1) and Requirements Signature page (page 2).
- Using the directions/forms provided, secure a narrative letter of recommendation (page 3) and a completed administrator rating form (page 4) from a supervising administrator who is directly familiar with and able to provide examples of your work.
- Respond to the following questions. Limit response to one page per question, single-spaced, and not smaller than 11 pt. Times New Roman font, putting your name on each page.Please note that each response will be read by a different screening team. Included in the application packet is a copy of the Scoring Rubric (page 5) that the selection committee will use to score your application.
- Specifically identify your involvement in the learning improvement efforts in your school, district, ESD, and/or at the state level. Describe any leadership roles you have assumed.
- Describe how your participation and leadership in school improvement efforts have contributed to a safe and caring learning environment in your school. As a result of your efforts and experiences, what have you learned about the relationship between a school environment that is physically, socially, and emotionally safe and the continuous improvement of student achievement?
- In the demographic context of the school setting(s) in which you work (have worked), how have or would you demonstrated a commitment to closing opportunity gaps for students of diverse race/ethnicity, poverty, English language learners, and/or students with disabilities?
If accepted into the Washington State-Funded Education Leadership Intern Program, I agree to:
Seek administrative employment in Washington State upon successful completion of the internship.
Participate in the intern program evaluation survey, and any follow-up studies.
Two-year internship program:
Are youentering the first year of a two-year intern program? ___Yes___No
If yes, do you want to split your award between two years?___Yes ___No
(If yes,this means that you will use half of your awarded days during the 2017–18 school year
and the other half during the 2018–19 school year.)
I have a valid and current Washington State teaching or ESA certificate.
Applicant NameApplicant SignatureDate
School/District______
Applicants, districts, and university program directors will be notified by Friday, May 26, 2017, of the names
of those individuals who are selected ornot selected for release time funding.
Administrator NarrativeRecommendation
of Intern Applicant
Intern Applicant’s Name
Recommending Administrator’s Name
School/District
Please address in one page the following topics regarding the applicant’s readiness to participate in the Washington State-Funded Education Leadership Intern Program. The program requires administrative endorsement of intern applicants. This recommendation will be treated as confidential by the Selection Committee. The Administrator’s Letter of Recommendation and Rating of Intern Applicant (pages 3and4)must be submitted by the intern applicant in one packet with all other application materials. To maintain confidentiality, the recommending administrator should enclose the completed pages 3and4 in a sealed envelope overlaid with his/her signature.
The recommending administrator’s narrative comments and numeric rating are given significant consideration by members of the committee making the final selection of applicants. Included in the application packet is a copy of the Recommending Administrator’s Narrative Scoring Rubric (page 6) that the selection committee will use to score the applications for the State-funded Intern Program. Further, the narrative letter needs to address the items in the Recommending Administrator’s Rating of Intern Applicant (page 4) to result in a consistent recommendation.
- Narrative Letter of Recommendation:
- Identify and assess the applicant’s level and quality of involvement in the improvement of teaching and learning in your school and/or district and any school improvement leadership roles assumed. Please provide specific examples.
- Provide a candid assessment of this person’s potential to become a performance-based school leader based on your assessment of their dispositions and emerging skills.
- Consider page two of the scoring rubric when responding.
- Limit your comments to one page on school or district letterhead with your signature.
- Administrator Rating Form:
Please complete the Administrator Rating of Intern Applicant form on the following page
(page 4).
Memorandum066-16M
Form SPI 1651 (17/18)Page 1November 2016
Recommending Administrator’s Rating of Intern Applicant
Intern Applicant:Recommending Administrator: ___
Circle the numeral for each criteria that best meets the applicant’s performance level as a beginning intern:
CRITERIA / 1 (Developing) / 2 (Average) / 3 (Strong) / 4 (Outstanding)Understanding of Strength/
Weaknesses
1234 / Has done little self-analysis or is not ready for leadership / Shows some awareness of attributes, but limited use for professional growth / Has an understanding of self, feedback from others, and uses some traits in leadership, participates in professional growth / Utilizes a deep understanding of strengths & weaknesses in leadership & uses all traits to set professional growth goals
Change Process
1234 / Shows some awareness of the role of leaders in the change process / Can analyze others’ use of the change process, but has little experience / Exhibits understanding of the first & second order change & uses it / Demonstrates life/school experience in using the change process effectively
Uses Data for Continuous Improvement and Decisions
1234 / Has general knowledge of school/class demographics but doesn’t use student data to make instructional decisions / Shows knowledge how to collect/analyze student data, but does not consistently use it to improve student learning / Uses multiple sources of student data to influence program & instructional decisions / Shows deep understanding of how to effectively use all types of data to improve student learning for the school/district
Relationships
1234 / Demonstrates strong emphasis on task-completion over relationships / Exhibits ability in building some relationships but not consistently / Develops and sustains effective working relationships with diverse stakeholders / Demonstrates trust-building & intentionality in nurturing relationships with diverse students, parents, staff, & community
Knowledge of Performance-based Teaching/Learning
1234 / Focused on teaching without awareness of impact on student learning / Uses knowledge of teaching/learning periodically to inform instructional decisions / Seeks refinement in teaching/learning continuously through student results & student voice / Demonstrates application and knowledge of performance learning in school & district work
Ethical Leadership
1234 / Shows some leadership instinctively & observes attributes/skills in others / Is learning to involve others, take risks, lead, & analyze the gap in their skills / Uses knowledge of a leader’s role in systems & inspires/motivates others / Demonstrates integrity & significant leadershipin school/district projects
Management of Self and Others
1234 / Exhibits a random style to complete projects individually & with others / Shows efforts to develop goals, organize, & manage projects / Works effectively to set goals, prioritize, organize, & manage multiple group/individual projects at once / Shows the ability to use feedback to anticipate, plan, & use leadership effectively to manage systems
Equity Leadership
1234 / Desires fairness and sameness for all / Appreciates, is respectful of differences; beginning to notice, act on disparities / Engages educators in taking action for equity in outcomes based on data / Acts on understanding of systemic issues of power, access, and inequity
Written and Oral
Communication Skills
1234 / Has some communication skills but not effective in both oral & written / Is able to use good communication, orally and in writing, but does not distinguish appropriateness for different audiences / Understands oral and written communication to different audiences, communicates effectively, & listens to others / Listens clearly communicates, orally and in writing, to different audiences for different purposes
Vision
1234 / Shows some awareness of the importance of shared vision and mission / Demonstrates an understanding of the importance of shared vision and mission / Collaboratively develops and implements a shared vision and mission / Facilitates the development, articulation, implementation, and stewardship of a vision of learning that is shared and supported by stakeholders
Total Points: ______(Out of a possible 40)
Recommending Administrator’s Name Position______
______
SignatureDate
Memorandum066-16M
Form SPI 1651 (17/18)Page 1November 2016
Washington State-Funded Education Leadership Intern Program Applicant ______
Applicant’sNarrative Scoring Rubric
MATERIALS / CRITERIA/RUBRIC:Applicant’s Narrative
Responses (page 2) / Question I: Learning Improvement Efforts
1Involvement in school-based improvement activities thus far has been focused in areas outside of student learning
3Demonstrated participation in school improvement efforts aimed at improving student outcomeswith limited evidence of leadership contributions
5Evidence ofinvolvement and leadership incontinuous improvement efforts to affect student learning such as facilitation of data analysis, leadership for alignment of curriculum/assessment/instruction, modeling of instructional best practices, coaching, etc.
7Extensive involvement as well as demonstrated leadership to implement continuous improvement efforts within a team or school that have resulted in demonstrated improvement in student outcomes / Question II: Safe and Caring School
Environment
1Limited participation and leadership in improvementefforts contributing to a safe and caring school learningenvironment
3Demonstrated participation in learning improvement efforts contributing to safe and caring learning environment; some understanding of relationship betweensafe environment and continuous improvement of student achievement
5Both demonstrated participation and demonstrated leadership in learning improvement efforts contributing to safe and caring learning environment; some understanding of relationship between safe environment and continuous improvement of student achievement
7Demonstrated participation and leadership in learning improvement efforts contributing to safe and caring learning environment; clearly expressed understanding of relationship between safe environment and continuousimprovement of student achievement
/ Question III: Closing Opportunity Gaps
1Equality focus; focus on fixingspecific student groups or their families to have more success in schools; works in isolation; works from personal knowledge or assumptions
3Appreciates/recognizes differences and needs among students; has begun to take action to bring equity of opportunity for these specified student groups; some involvement in equity work, capacity in early stages of development; considers data
5Evidence of applying an equity lens to work, has taken action among educators to change policies or practices for the specified student groups; has considered student or parent/family engagement; data leveraged for change
7Deep understanding of systemic issues contributing to opportunity gaps for traditionally marginalized students; experience targeting change and addressing issues of power; significant and effective collaboration with staff and communities, including marginalized students/communities to improve equity in outcomes for students; continuous improvement using cycles of inquiry address these issues
Washington State-Funded Education Leadership Intern ProgramApplicant ______
Recommending Administrator’s Narrative Scoring Rubric
MATERIALS / CRITERIA/RUBRIC: Circle the point values awarded for each question and write the awarded pointsin the spaces provided below. / COMMENTS
School Administrator Narrative Recommandation and Rating (pages 3 and 4) / Part I:Score narrative recommendation regarding the applicant’s involvementand leadership experience in improving teaching and learning.
0Very limited involvement; specific information not provided
1Limited involvement, experience, and/or actual leadership
3Some involvement, experience, and/or actual leadership
5Extensive involvement, experience, and/or actual leadership
7Exemplary involvement, experience, and actual leadership / Part II:Score narrative recommendation regarding the applicant’s potential in leading the improvement of teaching and learning.
0Very limited potential
1Limited potential
3Emerging potential
5Strong potential
7Excellent potential
/ Part III:Total of Numeric Rating from Administrator (page 4 in Application)
Assign Points Based on Total Rating Scores:
ScoresPoints
0 – 40
5 – 91
10 – 142
15 – 193
20 – 244
25 – 295
30 – 346
35 – 387
39 – 408
PAGE SIX POINTS /
Part I:
points out of a possible 7 /
Part II:
points out of a possible 7 /
Part III:
points out of a possible 8 /
Total points out of
a possible 22
43 POSSIBLE TOTAL POINTS:Questions/ 21
Recommendation/ 22
GRAND TOTAL/ 43
Memorandum066-16M
Form SPI 1651 (17/18)Page 1November 2016
Résumé
Applicant’s Name______
Professional Goal:
College/University Education and Degrees Earned:
Professional Certification:
Work Experience (beginning with current position):
Applicant information should be limited to one page; only items in the format above will be accepted. Space for each category may be adjusted, but do not exceed one page for your complete résumé. Do not replace with your own.
Personal Information Form
We would appreciate your voluntary cooperation in responding to the questions below. This information is strictly confidential and available only to authorized staff. Please check or write appropriate responses. Thank you.
Persons with a disability who need assistance in the application process or those needing this announcement in an alternative format may call TTY (360) 664-3631.
Completing this form is voluntary.
Office of Superintendent of Public InstructionPersonal Data Sheet
(Optional)
If you have decided to apply for the Washington State-Funded Education Leadership Intern Program, we would appreciate your voluntary cooperation in responding to the questions below. This information will assist in ensuring equal employment opportunity and is strictly confidential, available only to authorized staff and the hiring authority. Please check or write appropriate responses.
- Do you consider yourself to be Hispanic/Latino?
__ (Y) Yes, Hispanic/Latino
Hispanic/Latino – a person of Mexican, Puerto Rican, Cuban, South or Central America, or other Spanish culture or origin, regardless of race.
- What race categories do you belong to?Please check all that apply.
__ (I) American Indian or Alaska Native
__ (P) Native Hawaiian or Other Pacific Islander
Native Americantribe: ______
2.Are you: ___Male___Female
3.Have you ever been on active duty in the U.S. Armed Forces?___Yes___No
If yes, dates you served: From______to______
Disabled veteran: Percentage of disability: ____%
4.Do you have a physical, sensory, or mental condition that limits any of your major life functions? Yes_____ No_____
5.Date of birth: ______
Application Packet Checklist
A completed application packet submitted by the intern candidate MUST include the following:
Form SPI 1651 Page 1...... 2017 Application Form
Form SPI 1651 Page 2...... Application Requirements Form
(signature page)…………………………………..Responses to Questions I, II, III
Form SPI 1651 Page 3...... Administrator Recommendation
(in a sealed, signed envelope)
Form SPI 1651 Page 4...... Administrator Rating of Intern
(in a sealed, signed envelope)
Form SPI 1651 Page 7...... Résumé
Form SPI 1651 Page 8...... Personal Information Form
(optional)
Form SPI 1651 Page 9...... Application Packet Checklist
Deadline: / Friday, March 17, 2017Must be received by 4:30 p.m. at:
Washington School Principals’ Education Foundation
Education Leadership Intern Program
1021 8th Avenue SE
Olympia, WA 98501-1500
NOTICE: / Should the State Legislature NOT fund the Washington State-Funded Education Leadership Internships for the 2015–17 biennium, this application will be considered null and void.
Memorandum066-16M
Form SPI 1651 (17/18)Page 1November 2016