PLC Application You may start entering your information now, save your work, and come back later. The option to save is located at the bottom of the form. 1. YOUR INFORMATIONName First Last Email(Required) Are you the designated team coordinator?(Required) Yes No What is your job title?(Required) What is your racial/ethnic identity?(Required) Which best describes your job category? (Check one)(Required) Classroom-based, core content teacher Other teacher Instructional teacher Other administrator ABOUT YOUR SCHOOL2a. School Name(Required) 2b. School Location(Required) City State / Province / Region 3. What grade levels does your school serve?(Required) Early Childhood (Pre-K-1) Elementary (k-5) Middle School (6-8) High School (9-12) 4a. What are the racial/ethnic demographics of your students?(Required)Please provide the percentage for each row. Percentages should total 100% when added together.DemographicPercentage Add Remove Add Remove Add Remove Add Remove Add Remove4b. What are the other demographics of your students?(Required)Please provide the percentage for each row.DemographicPercentage Add Remove Add Remove Add Remove5. What group of students are you most concerned about? Which student group do you want to spotlight in your inquiry? Why? (This group is referred to as your "spotlight students.")(Required)ACADEMIC DATA6. Share reading, math, and writing proficiency scores for the student group you named earlier and for the overall student population. Feel free to use pre-COVID data from the last 3 years.(Required)Academic DataPercentage Add Remove Add Remove Add Remove Add Remove Add Remove Add Remove Add Remove Add Remove Add Remove Add Remove Add Remove Add Remove Add RemoveINSTRUCTIONAL STAFF DEMOGRAPHICS7. Instructional Staff Demographics(Required)Please provide the percentage for each row.DemographicPercentage Add Remove Add Remove Add Remove Add Remove Add RemoveEQUITY GOAL ALIGNMENTThe focus of the CRE by Design PLC is on improving instruction, not redesigning curriculum (lesson topics) to make it more inclusive. 8. In what ways does this align with your school and district’s equity goals?(Required)9. What past whole-school equity initiatives has your school carried out?(Required)Briefly describe initiatives and any observed impact on teachers’ or students’ learning.TEAM COMPOSITIONHave you identified at least four team members that fit the following team composition requirements? 10. Please provide the name, email, and primary role, racial/ethnic background of each of your team members.(Required)You must have at least four team members and no more than twelve team members.First NameLast NameJob TitleJob CategoryEmailRacial/ethnic identity Add Remove Add Remove Add Remove Add Remove Add Remove Add Remove Add Remove Add Remove Add Remove Add Remove Add Remove Add Remove11. If you are not the team coordinator, please name that person.First NameLast NameJob TitleJob CategoryEmailRacial/ethnic identityTIMEAs 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 independent.12a. How will your team create and protect time needed for the collaborative inquiry work of the team, individual data collection in classrooms, and learning content within the PLC? Briefly describe:12b. What options are available to protect your team's time? Check all that apply. Stipend Release time from teaching or other duties Repurpose other collaborative structure, e.g. common planning time Other Other Describe Briefly Other (Describe Briefly)TEAM COLLECTIVE KNOWLEDGE AND SKILLEach of your team members should have completed the Readiness Worksheet and shared them with you. Summarize the range of understanding and experience on your team by revisiting the following four questions from their Individual Readiness Worksheets: 13a. (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 January. 13b. (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)13c. (Taken from Question 11) What do you believe are the biggest challenges to getting students to improve their learning?(Required)13d. (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) 14. Did you or any of your team participate in a previous PLC cohort? Yes No
