A r c h i v e d I n f o r m a t i o n

National Awards Program for
Model Professional Development
Applicant Contact Information
- Category of application: (select one)
______ School
______ District
- Applicant Information
School or District Name: _______________________________________________
School or District Address:______________________________________________
__________________________________________________________________
Phone: __________________________ Fax: ______________________________
E-mail: _____________________________________________________________
Name of Principal (for school applicants): ___________________________________
Name of Superintendent: _______________________________________________
- Contact: (person in the school or district with whom U.S. Department of Education staff or site team can communicate about the application throughout the review process).
Name:_____________________________________________________________
Position:____________________________________________________________
Address:____________________________________________________________
Phone:___________________________ Fax:_______________________________
E-mail:______________________________________________________________
- Names and positions of the professional development planning team involved in the completion of this application:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Certification of Compliance with Laws Protecting Students with Disabilities:
Good teaching and learning must support the rights of all students to an appropriate education. Therefore, by submitting this application, the school or school district certifies that there are no findings of violations of the Individuals with Disabilities Education Act in an applicable U.S. Education Department monitoring report, and if there are such findings, the state (or district, as applicable) has corrected, or agreed to correct the findings. (Applicants are reminded of their obligations under section 504 of the Rehabilitation Act to ensure that their activities are accessible to persons with disabilities.)
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[Guidelines for Completing the Application]
[Applicant Demographic Profile ]