2019-2020 School Application To be eligible for consideration to have Center for Resilience and the ResilientKids curriculum in your classroom for the 2019-2020 school year, please complete and submit this application form by March 8, 2019. 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 AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands 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?Post ImageAccepted file types: jpg, jpeg, png, gif.