Application Form

NES Project Application

Data Fields

Your Contact Information (For the person completing the application)

Your first name:

Your last name:

Your e-mail address:

Your work phone:

How did you learn about the NASA Explorer Schools Project?

Edit Team Information

Team name: (name of school or school district if multiple schools)

Number of schools represented on the team:

School Information (Supply the following information for each school represented by the team.)

School Information

School name:

Address: (no P.O. Box number)

Number of teachers in school:

School type: (Choose from Public, Private, Charter, or Other.)

What is the last day of your current school year?

What is the first day of your next school year?

Lowest grade level in this school: (Pre-K, K, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or 12)

Highest grade level in this school: (Pre-K, K, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or 12)

Grade level(s) in this school where NES will be implemented: (4, 5, 6, 7, 8, 9)

School Demographic

Number of students in each school:

School ethnicity demographics: (What percentage of the total school population self-reports belonging to the identified ethnic groups? The total must be greater than 90 percent.)

Asian:

Black or African-American:

Hispanic/Latino(a):

Native American or Alaskan Native:

Native Hawaiian or Other Pacific Islander (Non-Hispanic):

White:

Other: (If other, please specify.)

Poverty:

Title I eligible: (yes/no)

Percent of students eligible for free or reduced school lunches:

Location: (Select from Urban, Rural, or Suburban.)

Accreditation: (Is this school accredited? Yes/no)

Team Members (minimum of 4 members)

Team member’s role (Select from pull down menu: Administrator, Teacher, or Teacher/Informal Educator.)

If an administrator:

• Indicate this team member’s administrative position: (choose from Superintendent, Assistant/Associate Superintendent, Principal, or Assistant Principal)

• Select the primary location for this administrator: (choose from schools listed).

• Select all schools associated with this administrator: (choose from pull-down menu).

• First name:

• Last name:

• E-mail address:

• Work phone:

• NASA Explorer Schools requires team members to be certified/licensed. Confirm (yes).

• Federal regulations require all team members to be United States citizens. Confirm (yes).

• Place of birth – City, State/Territory

• Country:

• Does this team member intend to remain at this school for three years? (yes/no)

• Administrative/teaching experience (years)

• Educational history: List this team member's degrees, certifications, and previous administrative and teaching experience.

• Professional development experience: Describe this team member's professional development experience from the past five years.

• Personal goals: List this team member's personal goals related to participation on the NASA Explorer School team.

• Describe this member's role on the NES team and the rationale for including this member on the team.

If a teacher or informal educator:

• Select the school for this team member from the schools that you previously entered. (Select from pull-down menu.)

• First name:

• Last name:

• E-mail address:

• Work phone:

• NASA Explorer Schools requires team members to be certified/licensed to teach. Confirm (yes).

• Federal regulations require all team members to be United States citizens. Confirm (yes).

• Place of birth – City, State/Territory:

• Country:

• Does this team member intend to remain at this school for three years? (yes/no)

• Will this team member have three years teaching experience by July 2007? (yes/no)

• Teaching experience (years):

• List this team member's degrees, certifications, and previous administrative and teaching experience.

• Describe this team member's current teaching assignments.

• Anticipated teaching assignments: (optional)

• Describe this team member's anticipated teaching assignment for the coming school year (if different than current assignment).

• Grade(s) this team member expects to teach in the coming school year:

• Professional development experience:

• Describe this team member's professional development experience over the past five years.

• Personal goals: List this team member's personal goals related to participation on the NASA Explorer School team.

• Team member's role: Describe this member's role on the NES team and the rationale for including this member on the team.

Team Leader: Select a Team Leader (from pull down menu of team members).

Team Questions:

1. Describe the educational issues/concerns for all populations entered earlier in the School Information section. (This question is unavailable until the School Information section is complete.)

2. List the improvement goals for science, technology, mathematics and geography for all schools represented on this team and how you are working to address these goals.

3. List the staff professional development goals for science, technology, mathematics and geography and discuss the professional development activities in meeting these goals for all schools represented on this team.

4. How do you involve families, parents and the community in the schools represented on this team?

5. Describe any partnerships that this team or district may have with other educational institutions, community partners, local business or government organizations.

6. Describe how this team’s involvement with the NASA Explorer Schools Project will benefit your team and help to accomplish goals in science, technology, mathematics and geography education.

7. Provide any additional information that you would like to share about your team and the proposed partnership with NASA.

Principal Letter of Support (Provide a letter of support from the principal of the school where the team lead teaches.)

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