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PLC Application

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SCHOOL IDENTIFICATION

Where does your team work?

1a. School Name(Required)

1b. School Location(Required)

City State / Province / Region ZIP / Postal Code

1c. District/ LEA Name(Required)

STUDENTS SERVED

2a. How many students does your school serve?(Required)

Fewer than 300

300-800

801-1500

1500+

2b. What are the racial/ethnic demographics of your students?(Required)

Please provide the percentage for each row. Percentages should total 100% when added together.

Demographic

Percentage

2c. What are the other demographics of your students?(Required)

Please provide the percentage for each row.

Demographic

Percentage

2d. What grade levels does your school serve?(Required)

Early Childhood (Pre-K-1)

Elementary (k-5)

Middle School (6-8)

High School (9-12)

ACADEMIC DATA

In the section below, you will be asked to provide English Language Arts and Mathematics proficiency scores disaggregated by demographics for certain grades: *If you serve elementary grades, please provide data from grade 4 *If you serve middle grades, please provide data from grade 8 *If you serve high school grades, please provide data from grade 10

3a. What percent of Grade 4 students in each category meets or exceeds proficiency in English Language Arts?(Required)

Enter a 2-digit number for each:

Academic Data

Percentage

3b. What percent of Grade 4 students in each category meets or exceeds proficiency in Mathematics?(Required)

Enter a 2-digit number for each:

Academic Data

Percentage

3c. What percent of Grade 8 students in each category meets or exceeds proficiency in English Language Arts?(Required)

Enter a 2-digit number for each:

Academic Data

Percentage

3d. What percent of Grade 8 students in each category meets or exceeds proficiency in Mathematics?(Required)

Enter a 2-digit number for each:

Academic Data

Percentage

3e. What percent of Grade 10 students in each category meets or exceeds proficiency in English Language Arts?(Required)

Enter a 2-digit number for each:

Academic Data

Percentage

3f. What percent of Grade 10 students in each category meets or exceeds proficiency in Mathematics?(Required)

Enter a 2-digit number for each:

Academic Data

Percentage

INSTRUCTIONAL STAFF DEMOGRAPHICS

4. What is the proportional racial and ethnic demographic makeup of your school’s instructional staff?(Required)

Enter a 2-digit number for each:

Demographic

Percentage

EQUITY GOAL ALIGNMENT

The goal of the CRE by Design PLC is to build educators’ capacities to equip students so that they develop new skills and stamina to close their own learning gaps and complete unfinished learning.

5a. In what ways does this align with your school and district’s equity goals?(Required)

5b. What recent school- or district-based equity initiatives has your school carried out?(Required)

TEAM COMPOSITION AND READINESS

Teams are key to translating culturally responsive practices into practices that improve student learning.

Each team will be facilitated by a team member you all select to be Team Coordinator. That person will be supported by a CRE by Design PLC facilitator to be the Team Coordinator.

6a. Team Coordinator Name(Required)

First Last

6b. Team Coordinator Email(Required)

6c. Team Coordinator Job Title(Required)

6d. Team Coordinator Job Category(Required)

Core content teacher

Non-core content teacher

Teacher leader (coach, mentor, team lead, etc.)

Instructional leader (principals, assistant principals, etc.)

Other

6e. Team Coordinator Racial/Ethnic Identity(Required)

African American/Black

Latino/a/x

Pacific Islander

American Indian/Alaska Native

White

6f. I am the _____________ Team Coordinator(Required)

Temporary

Permanent

TEAM MEMBERS

Have you identified at least four team members that fit the following team composition requirements?

You can have a maximum of 12 team members, but team composition must follow these criteria:

Core content teachers (i.e., math, science, ELA, history/social studies) *Include teachers who share students, teach the same core subject or use similar instructional practices if possible
Non-core content teachers: teams cannot be made up predominantly of specialists -- music, P.E., etc.
A teacher-leader, which can be a grade level team leader, department chair, or instructional coach.
An instructional leader: can be a vice principal, etc.
Teams cannot include paid consultants

7a. Please provide the name, email, and primary role, racial/ethnic background of each of your team members.(Required)

Remember, you must have at least four team members and no more than twelve team members. For "Job Category," please indicate one of the following: Core content teacher, Non-core content teacher, Teacher Leader (coach, mentor, team lead, etc.), Instructional leader (principals, assistant principals, etc.), or Other (give description)

First Name

Last Name

Job Title

Job Category

Email

Racial/ethnic identity

TIME

As you know from the PLC Overview, the PLC isn’t like traditional “sit and get” PD. It requires a more rigorous, ongoing commitment to learning new culturally responsive moves, tracking their impact on your students’ learning, and making changes to help students become more cognitively independent. This work takes place alongside your ongoing work as educators.**[ see time estimates below]

8a. How will you create and protect time needed for the collaborative inquiry work of the team, individual data collection in classrooms, and learning content within the PLC? Check all that apply.(Required)

Stipend

Release time from teaching or other duties

Repurpose other collaborative structure, e.g. common planning time

Other

Other Describe Briefly

Other (Describe Briefly)

**Here are the approximate estimates of PLC-related activities:

Individual review of online modules and associated materials (Approx. 2.5 hrs/month)
Individual instructional work with focal students (open ended)
Individual and collective work grounded in inquiry activities (observation, analyzing data, reflection, reviewing and providing feedback, etc.) Approx. 10 hrs/month
Site Team meetings (Approx. 5 hours/month)
Virtual meeting with CRE by Design community) (Approx. 2.5 hrs/month)

TEAM COLLECTIVE EXPERIENCE

Team Readiness Reflections

Use your summary of team members’ Readiness Reflection Worksheets to answer the questions below.

9a. (Taken from Question 2) How much of Culturally Responsive Teaching and the Brain have potential team members read? Choose one:(Required)

All members have read the entire book.

A majority of members have read the entire book, and the rest have read parts of it.

A minority of members have read the entire book, and the rest have read parts of it.

Some members have read all or part, and others plan to read it before October.

9b. (Taken from Question 7) What types of experiences have your teammates had talking with each other about the intersection of equity, anti-racism, and instruction?(Required)

9c. (Taken from Question 11) What do you believe are the biggest challenges to getting students to improve their learning?(Required)

9d. (Taken from Question 16) Which of the following inquiry-based professional learning experiences do members of the team have experience with?(Required)

Data Inquiry Cycles with student data

Peer Observation Cycles

Instructional Rounds

Lesson Study

National Board Certification

Looking at Student Work Protocols

None of the Above

Other

Exerience Other

(Describe briefly)

9e. What percent of team members have reported engaging in inquiry-based professional learning experiences?

SCHOOL INSTRUCTIONAL CULTURE

How often does each of the following occur in your school?

10a. Teachers talk openly about their own identities and implicit biases.(Required)

Always

Frequently

Occasionally

Seldom

Never

10b. Teachers in our school observe each other's teaching.(Required)

Always

Frequently

Occasionally

Seldom

Never

10c. Teachers administer common formative assessments.(Required)

Always

Frequently

Occasionally

Seldom

Never

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