Teacher Leaders

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1. First Name

First Name

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2. Last Name

Last Name

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3. School:
If we missed your school on the list, we apologize. Please select Other from the drop down menu and fill in the Other field.

School: If we missed your school on the list, we apologize. Please select Other from the drop down menu and fill in the Other field.

Other (please specify)

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4. Email address:

Email address:

5. Your primary role in the building:
Please select Other from the drop down menu and complete the Other field if your primary role is not listed.

Your primary role in the building: Please select Other from the drop down menu and complete the Other field if your primary role is not listed.

Other (please specify)

6. If you selected teacher as one of your options above, what grade levels do you teach? (again, select all that apply)

If you selected teacher as one of your options above, what grade levels do you teach? (again, select all that apply) 7

8

9

10

11

12

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7. Subject
Please check off Other and enter the subject in the Other field if a subject is not listed.

Subject Please check off Other and enter the subject in the Other field if a subject is not listed. Other Career Preparation English Language Arts	Health and Physical Education Mathematics Science and Technology	Social Studies Visual and Performing Arts World Languages
Other (please specify)

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8. Did you attend a 2008 MLTI Fall Meeting?

Did you attend a 2008 MLTI Fall Meeting?

9. Besides the Fall Meeting, have you received training on the SAMR model and TPCK elsewhere?

Besides the Fall Meeting, have you received training on the SAMR model and TPCK elsewhere? Yes

No

If yes, where?

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10. One of the teacher leader requirements is to use the TPCK and SAMR models to guide your school's leadership team in establishing a facilitated process for planning and goal setting as it pertains to the classroom.

Have you started this conversation with your principal/leadership team yet?

One of the teacher leader requirements is to use the TPCK and SAMR models to guide your school's leadership team in establishing a facilitated process for planning and goal setting as it pertains to the classroom. Have you started this conversation with your principal/leadership team yet? We have met at least once

We have a meeting planned in the next month

We have a meeting planned in the next two months

A meeting has not been scheduled/discussed yet

11. What are your school goals and how can you use these models to see how tech fits into them?
How can TPCK and SAMR inform our school PD for the year?

What are your school goals and how can you use these models to see how tech fits into them? How can TPCK and SAMR inform our school PD for the year?

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12. Do you have a Studywiz login?

Do you have a Studywiz login? Yes

No

Don't Know

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13. For what technology integration topics do you most need professional development training?

For what technology integration topics do you most need professional development training? 1.
2.
3.
4.
5.

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14. One of the requirements of being an MLTI Teacher/Leader is participating in an online course. A special 4-week course is being developed for MLTI Teacher Leaders. The course will be presented between February 25 and April 15th. There will be three sessions. Which of these session dates will best fit your schedule? Please indicate 1st, 2nd, and 3rd choices.

	1st Choice	2nd Choice	3rd Choice
Make Up Session (dates to be finalized - will be after April Break)	One of the requirements of being an MLTI Teacher/Leader is participating in an online course. A special 4-week course is being developed for MLTI Teacher Leaders. The course will be presented between February 25 and April 15th. There will be three sessions. Which of these session dates will best fit your schedule? Please indicate 1st, 2nd, and 3rd choices. Make Up Session (dates to be finalized - will be after April Break) 1st Choice	2nd Choice	3rd Choice
Session A: Feb 25 - March 24	Session A: Feb 25 - March 24 1st Choice	2nd Choice	3rd Choice
Session B: March 11 - April 8	Session B: March 11 - April 8 1st Choice	2nd Choice	3rd Choice
Session C: March 18 - April 14	Session C: March 18 - April 14 1st Choice	2nd Choice	3rd Choice

1. 2008 - 2009 MLTI Teacher Leader