Kentucky Department of Education and Center for School Safety
ANNOUNCE...
Kentucky Behavior Initiative 2000
(An Expansion of the Original 'Model School' Pilot Site Project)
Future Demonstration Sites to be Known As:
Kentucky Instructional Discipline and Support Schools
or
"KIDS" SCHOOLS
SCHOOL APPLICATION FORM
SEND APPLICATIONS (plus copies) TO:
Laura McCullough
Kentucky Behavior Initiative: KIDS Demonstration Project
Kentucky Department Of Education
Capital Plaza Tower, 8th Floor
500 Mero Street
Frankfort, Kentucky 40601
Application Deadline:
May 26, 2000
Note: To apply you may use this form or you may submit this application through use of a word-processing program (in which case be certain to retype all the section headings and include all the necessary signatures and assurances on page 5 & 6 of this application). Your total application should not exceed 10 pages (12pt font or larger), excluding attachments. Please send original and two copies of this application (no faxes accepted); keep a copy for your records. This School Application Form is also
available at
-- Districts will be notified of selection by June 20 --
Kentucky Behavior Initiative 2000
New "KIDS" Demonstration Site Schools
APPLICATION FORM
(Please send original and 2 copies - No faxes accepted)
I. School Site Information:
School Name:______District:______
County:______
Principal Name:______Email:______
School Phone: ______
School Fax:______
School Address:______
Total Enrollment:______Total # School Faculty: ______
__Elementary or __Middle (check one or both)
Grade Level Range:______
School Calendar:
Start Date______End Date______
Fall Break______Spring Break______
District Contact:______Position:______
Phone:______Email:______
II. Knowledge / Exposure / Experience with Proactive Instructional Discipline or Multi-Level Positive Behavior Support Approaches:
A. List any professional development activities which administrators or staff have attended which indicate prior interest or commitment to positive discipline approaches.
B. List any current or previous efforts to develop positive discipline practices in your school.
III. Current School / Discipline Profile:
Provide a brief current description of the following... (please label and address each sub-item, A-E)
A. Current discipline approach (include philosophy, office referral and schoolwide discipline policies and procedures) and current status of disciplinary concerns (include insights and current strengths/weaknesses which relate to student behavior and future needs).
B. Summary of key school safety, discipline, and student behavior data.
C. Related instructional factors (based on your consolidated plan, summarize recent
instructional planning initiatives, outcomes, state testing scores, and instructional goals for the coming year).
D. What programs or activities are currently in place to support or assist students with behavior problems?
E. What other current school improvement efforts might either compliment or compete with this initiative for the time, energy and attention of your staff?
IV. Statement of Need Consistent with Project Intent
A. Rationale: State WHY you are choosing to apply for this project. While there are significant advantages to being included, there are also significant commitments of time and energy required schoolwide to participate - why does your school want to make this a priority and agree to do the work required over two to three years to implement this model?
B. Consolidated Plan: To what extent have you identified safe schools, behavior or
discipline needs and concerns as goals or priorities in your Consolidated Plan? Describe or provide a copy of relevant parts of your plan.
V. Collaboration with Community-Linked Initiatives, Agencies or Persons
A. Briefly describe existing or planned community-linked violence prevention, youth at-risk, student/behavior support or other relevant efforts which involve other agencies (e.g., mental health, social services, Big Brother/Big Sister) or multidisciplinary/community personnel.
B. Describe your efforts to secure an agency representative to participate on your KIDS team - see p.6 details regarding team membership (this person would participate in training periodically).
(*We encourage you to solicit signed agreements or letters of support which gain future commitments from local or regional Community Mental Health Center(CMHC) personnel who work with children to participate directly with the school in training and implementation of this KIDS multi-level model; these CMHCs will have some SFY 2000-2001 incentive funds available from the Department of Mental Health and Mental Retardation Services to help support their collaborative involvement (ie, participation in training and implementation of this KIDS initiative at your school). In addition, CMHCs may be able to assist schools over time with individually targeted student interventions, especially at the intensive level.) If you are able to obtain a written agreement or letter of support, attach a copy and note here (B).
VI. Commitments from Administrators, Faculty/Staff, and District:
Our three-year experience with pilot site schools has shown that the following are critical elements which appear to influence the success of schools implementing this model: 1) active administrative leadership, participation, and continuity, 2) widespread faculty involvement and commitment, 3) representative team membership across all segments of the school (see next page for details) , 4) district commitment and support of the project, including provision of substitutes required for extensive team training and staff PD, and 5) school belief in the value of a proactive instructional approach to discipline and willingness to use school-based professional development days to educate and involve all staff.
A. List and attach Letters of Support for this initiative from entities within your school community (e.g., Superintendent, School Board, Principal, Site-Based Council, School Discipline Committee, PTA, FRYSC Advisory Committee, etc.).
B. Attach a signed Faculty Roster which indicates that a majority of this school faculty have been informed (overhead transparency masters to assist you are enclosed) and are providing a signature to indicate their understanding and general support of this initiative.
VII. Team Composition and Acknowledgement
Composition of the Team should be as follows:
• Eight to ten persons who represent the staff and community, who are supported (or selected) by the school faculty and who are individually committed to participation in project training (8-10 days/yr) and school-based follow-up (at least 50% of team are school-based classroom teachers and staff);
• Balanced so that team is representative of teachers from general education across the range of grade levels and subject areas(including the arts), plus one special educator and one classified staff
• Includes a person who has behavior expertise or works with troubled students at your school (e.g., counselor, school psychologist, school support staff, school social worker, FRYSC staff);
• Principal must agree to be an active primary team member and attend all or most trainings; two administrators preferred who can rotate if necessary - both must stay informed (i.e., assistant principal can provide back-up to the principal);
• Team should include at least one representative from a community agency that offers behavior support services to children (e.g., CMHC Children's Mental Health staff, KY IMPACT Service Coordinator or LRC, or staff from Departments of Community-Based Services, Juvenile Justice, Administrative Office of the Courts, etc.) and a parent representative (optional)who can attend periodically.
Please list, by name and title, the members of the school team. Each member will sign beside his/her name to acknowledge a commitment to consistent participation throughout the school year.
NAME TITLE/ POSITION SIGNATURE
______
______
______
______
______
______
______
VIII. List of Assurance Statements
Submission of an application requires a commitment to certain assurances as listed below. The signatures of the Superintendent and Principal signify agreement that the required commitments will be upheld at the school and district level.
Principal:
A.I assure that the school team, including myself as principal, will participate for 2-3 years in quarterly KIDS professional development training sessions. (8-10 days/ year; initial training in central location, then quarterly in region)
B.I assure that substitutes and other financial costs for school-based team members to attend 4-5 two day trainings/ year will be provided/ paid by the school/district and that project expenses will be given priority in budgeting.
C.I assure there will be time made available for the school team to plan and to meet with the entire faculty to ensure regular schoolwide faculty involvement between training sessions regarding behavior issues.
D.I assure the collection of evaluation data in my school (as required by the Behavior Initiative 'KIDS' Project) will be accomplished in a timely manner.
E.I assure our willingness to share our experience, including successes and challenges, with other schools in our district and statewide with those who are interested in improving behavioral outcomes for students. I understand this may include allowing site visits to our school and may also at a later time include, on a voluntary basis, conducting conference sessions or workshops.
F.I assure that my faculty has been informedof the key ideas and major activities (see overheads provided) involved in this project and that substantial staff commitment is present to implement this initiative.
______
Signature of PrincipalDate
Superintendent:
I commit to recognize this initiative as a district priority, provide support as needed and to allow substitute teachers to be arranged as much as possible for this project.
______
Signature of SuperintendentDate
1