The purpose of this survey is to submit a request for a collaboration project with one or more Escambia County, Florida Public Schools. Upon completing this survey, you will be asked to send a verification e-mail to the office of Curriculum & Instruction. A team consisting of District curriculum professionals will review your request and contact you regarding the outcome of the review. Please answer all questions completely.

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* 1. I am currently employed with

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* 2. Please provide your contact information:

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* 4. The proposed collaboration project is designed to serve _______ students.

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* 5. The proposed collaboration project is designed for the following content area (select all that apply).

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* 6. Briefly describe the proposed collaboration project. Please be sure to include information regarding the desired outcome and the evaluation process used to measure outcomes.

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* 7. The proposed collaboration project is designed to:

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* 8. Have you developed a proposed budget for this project?

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* 9. Indicate all anticipated costs associated with this project.

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* 10. Identify amounts of all requested and/or anticipated funding sources.

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* 11. If approved, who is the person in your organization who will be responsible for monitoring the progress of this project?

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