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 Demographic Profile

1. Total number of students: _____________

2. Type of school(s):
   __ Pre-kindergarten
   __ Elementary
   __ Middle
   __ Junior High
   __ Senior High
   __ Other (please specify)__________________________________

3. Population Category:
   __ Urban
   __ Suburban
   __ Rural

4. Racial/ethnic composition of the students in your school(s):
   ____ % American Indian or Alaska Native
   ____ % Asian
   ____ % Black or African American
   ____ % Hispanic or Latino
   ____ % Native Hawaiian or Pacific Islander
   ____ % White

5. ____ % Limited English Proficient students in the school(s)
   ____ Number of languages (please specify languages):__________________________

6. ____ % Students who qualify for free or reduced price lunch

7. ____ % Students receiving special education services

8. Special characteristics of your school or district which you believe are relevant to your application:
   ___________________________________________________________________
   ___________________________________________________________________
   ___________________________________________________________________
   ___________________________________________________________________
   ___________________________________________________________________

[Applicant Contact Information]

[Application Checklist]