RULER TRAINING REGISTRATION FORM

Transcription

1 RULER TRAINING REGISTRATION FORM ORGANIZATION INFORMATION Name of School: Mailing Address: City: Zip Code: : Fax: Principal/Head of School: : : PARTICIPANTS (Included in Cost of the Program) #1 Name Title #2 Name Title #3 Name Title NO MORE THAN TWO ADDITIONAL PARTICIPANTS (at $1,500 additional per person) #1 Name Title #2 Name Title

2 Please complete all of the following information/answer all of the following questions (if you require additional space, please attach a separate sheet to this application): 1. We are a (check the box that applies): Public school Public charter school HAIS Full Member School 2. Provide a brief description of your school, your students and your community. Provide basic demographic data and grade levels served. 3. Describe any social and emotional learning (SEL) programs currently delivered to students in your school. If no programs are delivered, please indicate as such. If a program or programs are delivered, please provide the name of the program(s), a short description of the program(s), and how many and who receives/participates in the program(s).

3 4. Please attach a copy documenting your most recent accreditation report status or documentation demonstrating that you have initiated the accreditation process and will be completing a full-visit within the next two (2) years 5. Please attach a letter of commitment from the principal or head of school. NOTE: By completing the registration form, you are committing to participate regardless of scholarship receipt. If you apply for financial support by Friday, September 22, 2017, but do not receive enough to be able to participate, you must notify HCF by Friday, October 6, 2017 to withdraw from the program without penalty. DEADLINE If not applying for financial support or a travel grant, please submit this registration form no later than Friday, October 6, Your non-refundable deposit of $2,000 will be due on or before Friday, October 20, If you are interested in applying for financial support and/or a travel grant, please complete this registration form along with the following appropriate application forms by Friday, September 22, All forms (registration, scholarship application, and/or travel grant application) must be submitted to Natalie Millon at HCF at nmillon@hcf-hawaii.org PROGRAM SUMMARY School implementation teams will receive: Blended learning experience, which includes two (2) days of training to be held in Honolulu (see attached tentative agenda), and two (2) online courses A step-by-step process for implementing and sustaining emotional literacy learning and skill building in classrooms A comprehensive user-friendly manual to support instruction Concrete tools that can be implemented immediately into Pre-K to 12 classrooms Implementation coaching sessions (4 hour-long virtual sessions) Ongoing support vis-à-vis webinars and the RULER Online community Monthly newsletters Interactive classroom materials School implementation teams will be required to: Attend both days of the training set for December 6 and 7, 2017 in Honolulu; Provide training to the rest of their school s faculty and staff using online resources and other support from Yale s RULER team; and Participate in an evaluation of the RULER training and program.

4 SCHOLARSHIP APPLICATION FOR 2017 RULER TRAINING IN HONOLULU Name of School: Mailing Address: City: Zip Code: Principal/Head of School: : : 1. For public or public charter schools, please note if you are located in one of the following complex areas as special funding may be available to support your participation: Campbell/Kapolei complex Pearl City/Waipahu complex Windward district Nānākuli/Wai anae complex Aiea/Moanalua/Radford complex 2. For private schools, are you a full member of HAIS: Yes No For questions 3-5, if you require additional space, please attach a separate sheet to this application. 3. Please explain why you are interested in the RULER training and program for your school. Why is this program needed at your school? 4. Please explain how you plan to move forward with the RULER and/or other SEL program for your school following the training.

5 5. Please explain why you are requesting financial assistance for this program. 6. Amount of support requested: Partial support: $. We are able to provide the balance of $ in matching funds. Full support ($6,000). DEADLINE Please complete and submit this scholarship application form with your completed RULER registration form by Friday, September 22, 2017 to Natalie Millon at HCF at nmillon@hcf-hawaii.org These scholarship are available through the generous support of The Kamehameha Schools, and the Omidyar Ohana and Koaniani Funds at the Hawai i Community Foundation. This training is being offered by the Yale Center for Emotional Intelligence in partnership with the Hawai i Association of Independent Schools and the Hawai i Community Foundation with support from St. Andrew s Schools.

6 Staff Use Only: Approved/Initials: Grant ID#: Pillars of Peace Hawai i 2017 Travel Grant Application Form - Interisland Approved participants from the Neighbor Islands may be provided with a travel grant to cover air and ground transportation, and hotel accommodations to attend the RULER training in Honolulu on December 6-7, Travel grants for participants will be issued on the first day of the training program. If the participants do not attend the meeting, the grant agreement will be null and void. Please note the check will be issued to the participant s affiliated organization/school. Each participant will be responsible for making their own travel arrangements. Any funds not needed for this travel, should be returned payable to the Hawai i Community Foundation with notation of Pillars of Peace Hawai i, at 827 Fort Street Mall, Honolulu, HI, Expense Rate Per Individual Air transportation RT Interisland Travel $ Hotel Accommodations (2 nights) $ Ground Transportation $ Maximum Total Available per Attendee $ Please submit completed applications to Natalie Millon nmillon@hcf-hawaii.org by Friday, September 22, If you have questions, please call Natalie at , or toll-free at Organization Information PAYMENT WILL BE MADE TO THIS ORGANIZATION/SCHOOL Name: Address: : Fax: Participants Name 1: : Name 2: : Name 3: : Title: : Title: : Title: : One signature required: Signature Date Print or Type Name and Title DEADLINE Please complete and submit this travel grant application form with your completed RULER registration form by Friday, September 22, 2017 to Natalie Millon at HCF at nmillon@hcf-hawaii.org