2019-2020 School Application

Name*

First Last

Email*

Phone*

School*

Type of School*

School Phone Number*

School Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

What is your role at the school?*

How long have you been at the school?*

What grades are at your school?*

Number of Faculty*

Number of Students*

Will you be the primary contact for the school's collaboration with Center for Resilience?*

Yes
No

Name*

Please list the primary contact along with their email and phone number.

Role*

Email*

Phone*

Please describe your school's climate and culture.*

Philosophy, acronyms, goals, etc.

In what ways are you currently supporting your students' social and emotional well-being?*

Please describe why you would like to partner with Center for Resilience.*

Are there any specific issues at the school you are hoping to address?*

Yes
No

Please describe how you think this work can be helpful to address these issues.*

What other outside resources are you currently working with to support your students' character education and social and emotional needs?*

Please describe the scope of your desired implementation - (Number of students, number of classrooms, weekly frequency).*

A general overview is fine to give us a better understanding of staffing needs on our end.

Cost per classroom or advisory is $3,800 for this year-long program. Our support levels for funding are based on the percent of students receiving free and reduced lunch (FRL) support. What was the percent of FRL for 2018-2019?*

For which tier are you applying?*

Tier One
Tier Two
Tier Three
Tier Four

How do you plan to secure funding for the balance of the implementation cost?*

What type of data do you collect?

Behavior referrals, suspensions, nurse visits, etc.

Would you be willing to share this data with Center for Resilience to help measure program impact?*

Yes
No

Do you have any additional comments or questions you would like us to know when considering this application?*

Yes
No

Please explain:*

This program spans 32 weeks, from September to June. Prior to beginning, there is a 2-hour orientation required for all teachers and administrators who will be working with Center for Resilience. When could this be scheduled?

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2019-2020 School Application

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