Nonpublic School

Professional Development Proposal

To Nonpublic Staff and Administrators: This form must be attached to a Pre-approval Request Form when requesting a professional development activity that is not a conference or workshop. If you do not have a description or something that can be attached to the pre-approval request that describes the activity and reasons for the activity/request, you would want to use this form.
Examples:
  • Mentoring/Coaching services
  • Consultation services
  • Curriculum/Technology planning
  • Books to be ordered for professional development related to a Professional Learning Community or Teacher Study
  • Stipends for teachers/staff to work as part of the professional development activities described above**
(this is NOT an exhaustive list)
**If staff stipends are being requested for the proposed professional development activity, please include that information in the Budget Proposal. Please answer all the questions on the form provided. If services from a third-party provider are being requested, be sure to include all the required information below.
School: ______/ Your Name: ______
  1. In at least 10 sentences, please describe the proposed professional development activity. The description should be long enough to provide sufficient information about the professional development activity for the Funded Programs Office staff to understand the scope of the request. It must address information on at least the following items:
  1. the learning and activities expected of the provider/staff
  2. the duties to be performed by the mentor/staff/consultant
  3. types of services provided and
  4. how the contractor/provider will deliver the services (e.g., direct instruction, tutoring, workshops, professional learning communities, consultation, observations, online, etc.)

  1. What are the overall goals of the professional development activity/services to be delivered? Goals should show a connection to:
  1. the services and activities described in #1, i.e., the expected learning outcomes for participants
  2. how the professional development activity will impact student learning
  3. how learning/activities will be shared with the school community

  1. Describe the methods for evaluating the effectiveness of the services to be provided. This information must include:
  1. How will the outcome(s) be measured, including what methods will be used to evaluate whether the services were effective? (e.g., survey, observation, evaluation of student data, etc.
  2. When will a follow-up evaluation be conducted? By whom?

  1. How does this activity fit into the overall Professional Development Plan that has already been agreed upon?

  1. If the activity involves travel (e.g., out of town consultant), is there a comparable resource locally?

  1. If the activity is not secular, neutral and non-ideological can it be clearly separated so that the district only supports secular portions?

  1. Check which PD requirements this activity will fulfill (check all that apply):
□Improve and increase teachers’ knowledge of the academic subjects they teach; please name subject: ______
□Improve classroom management
□Directly aligned to state academic content or achievement standards
  1. Who will participate? Names should be listed on the Pre-approval Request form or, if more than two staff, attach a list including staff name(s) and position(s).

Third Party Contractor Information

If this request includes contracting for services from a provider (no matter the amount), please complete the information below regarding the proposed service provider/consultant.

Name of Service Provider/Consultant:
Consultant Contact Information: / Address:
City, State, Zip:
Phone:
Fax:
Email:
List name of responsible party for signing the Contract.
(e.g., Sole Proprietor/Contractor, President, CEO)
Nonpublic school staff recommending this contract. / Name:
Title:
Attach a resume or curriculum vitae of a consultant or list/attach the credentials of the providing organization. / Resume/Vitae Attached? Yes No
If no, reason:
List the total amount request (in dollars) for the contract.
List the rate of pay, including whether a per hour/per day fee.
List total hours/days of service.
List other pertinent information regarding the costs of the contract (e.g., travel costs, billing cycles, etc.).

07/01/2016

Budget Proposal

For each area below, please list the person for which payment is being requested, the activity or purpose for the payment, hours and costs. Add more cells as is appropriate.

Consultant/Staff Name / Position / Activity/Purpose
(e.g., service provided, stipend, etc.) / Cost per Hour / Total Hours / Total Cost / Funding Source
(Title I, II, III) / G/L Code
FOR MPS FPO USE ONLY
Reviewed by MPS Funded Programs Staff (Name): / Date:
Comments:

07/01/2016