Planning Form

Summer of Innovation #1 (Parental Consent)

Appendix D NASA SOI 3-24-11

Parent Consent Form/Survey

OMB: 2700-0150

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Appendix D: Awardee Planning Form

Definition of Key Terms:


  • Awardees: the ten entities that have entered into agreement with NASA to implement SoI.


  • Key partners: the awardee's partner organizations that will play a critical role in the project’s ability to meet NASA’s requirements for SoI (e.g., a partner who provides additional funding or is responsible for the recruitment of students and teachers should be considered a key partner whereas a partner whose main contribution is providing snacks/lunch should not be listed as a key partner). 


  • SoI locations: the cities or towns where the SoI program activities are to be implemented.


  • Classrooms / Camp sessions: a defined set of student activities occurring during the summer. Note: because some program activities may occur only in one classroom/camp session within a location, a classroom and location may be one and the same in some instances.


  • PD sessions: a defined set of SoI professional development opportunities for certified teachers. Note: because some professional development activities may occur only in one PD session within a location, a session and location may be one and the same in some instances.



Location of the SoI Project

  • Please describe general structure of program: e.g., 10 one-week sessions across 10 cities.

  • Expected location(s) where SoI student activities will be implemented?

    1. [City] [State] [number of camp sessions] [Program name]

    2. [City] [State] [number of camp sessions] [Program name]

    3. [City] [State] [number of camp sessions] [Program name]


  • Expected location(s) where SoI teacher activities will be implemented?

    1. [City] [State] [number of PD sessions] [Program name]

    2. [City] [State] [number of PD sessions] [Program name]

    3. [City] [State] [number of PD sessions] [Program name]


Key Partners

  • Name of partner 1:

    • At which location(s) will this partner be involved?

    • Which category best describes this partner?

      • School / school district

      • State department of education

      • College or university

      • Non-profit/community based organization

      • For-profit organization or company

      • Foundation

      • State or local government association

      • Other, please specify:______________________

    • Has your organization collaborated with this partner before?

      • If yes, please describe:­­­­­­­­­­­­­­­­­­_______________________

    • What role do you expect this partner to fulfill? (Check all that apply.)

      • Funding

      • Student recruitment

      • Teacher and/or educator recruitment

      • Existing student program(s) into which SoI will be integrated

      • Lead the professional development activities

      • Venue for student or teacher activities

      • Transportation to and/or from program (e.g., bus service to and from program)

      • Other, please specify:_____________________________________


[If multiple partners, section will repeat for each partner]

  • Are you continuing to search for partners?


Student Program in [Location 1]

  • Total expected number of middle school students who will participate in SoI activities during summer 2011_____

  • Total expected number of middle school students who will participate in SoI activities during the school year_____

  • Expected number of middle school students per classroom or camp session during the summer _____

  • What percentage of students are you targeting in the following categories?

    • Female _____

    • Low-SES _____

    • Black/African American ______

    • Latino/Hispanic ______

    • Native American _______

    • Other, please specify ______

  • Expected number of hours of interactive STEM activities utilizing NASA content during the summer _____

  • Expected number of hours of SoI interactive STEM activities utilizing NASA content during the school-year _____

  • What proportion of the following educators will provide the instruction of the interactive STEM activities utilizing NASA content to the students?

    • Certified teachers_____

    • Non-certified teachers________

    • Other, please specify:___________________ ______

  • Which of the following NASA themes align with the focus of the SoI curriculum?

    • Theme 1

    • Theme 2

    • Theme 3

    • Theme 4

    • Other, please specify

  • Which of the following NASA content /curriculum materials are you planning on using?

    • Drop down list of the modules NASA is offering

  • Do the answers to the questions x through Y above vary by camp session and/or location?

  • [If yes, then section will repeat for each camp session or student location where this varies]


Expectations for NASA in [Location 1]

  • Expected total number of hours of professional development for each certified teacher provided by NASA _____

  • Curriculum focus of NASA PD [drop down list of the modules NASA is offering]

  • When will NASA provide PD? (check all that apply.)

    • Before student summer activities.

    • During student summer activities.

    • After student summer activities but before student-school year activities.

    • During student-school year activities.

    • After student-school year activities.


Professional Development for Certified Teachers in [Location 1]

  • Expected total number of teachers who will participate in professional development:

    • Before summer activities _____

    • During summer activities _____

    • After summer, before school-year activities _____

    • During school-year activities _____

    • After school-year activities _____

  • Will you be providing the professional development for certified teachers?

    • If so, approximately how many hours of training will be provided?

    • Who will be providing the training? (Check all that apply.)

      • Awardee organization.

      • Partner organization.

      • NASA.

      • Other: _______________________________.

  • Expected total number of hours of professional development for each certified teacher:

    • Before summer activities _____

    • During summer activities _____

    • After summer, before school-year activities _____

    • During school-year activities _____

    • After school-year activities _____


Training for Educators in [Location 1]

  • Will you be providing training to your educators, i.e., non-certified teachers?

    • If so, approximately how many hours of training will be provided?

    • Who will be providing the training? (Check all that apply.)

      • Awardee organization.

      • Partner organization.

      • NASA.

      • Other: _______________________________.

  • When will the training be provided? (Check all that apply.)

    • Before student summer activities.

    • During student summer activities.

    • After student summer activities but before student-school year activities.

    • During student-school year activities.


  • Do the answers to the questions x through Y above vary by PD session or location?

  • [If yes, then section will repeat for each teacher PD session or location where this varies]



National Aeronautics and Space Administration - Summer of Innovation Appendix D-5

File Typeapplication/msword
File TitleAppendix D: Awardee Planning Form
AuthorRhodesH
Last Modified ByRhodesH
File Modified2011-03-24
File Created2011-03-24

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