Application for MTSS for Staff Wellbeing Learning Cohort 2023-24 Survey

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* 2. District Low Income Rate

What is your districts Free and Reduced Meal rate? If 50% or higher skip to "Number of employees in district" as next question

Number of schools

Number of schools with free and reduced meal rates 50% or higher

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* 3. Employee Demographics (approximate is OK)

# of employees in district

% Black/African American Staff

% Indigenous, Alaskan Native or Native American Staff

% Hispanic and/or LatinX Staff

% Asian and/or Pacific Islander Staff

% White non, Hispanic Staff

% Bi-racial, % Other or % Race Unknown Staff (please specify)

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* 4. Is there any additional information you'd like to share about the data entered in the racial breakdown of your staff teams?

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* 5. Why is your district interested in joining this cohort?

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* 6. How would you describe the buy-in or support of your district administrators for your participation in this cohort and/or workforce wellness efforts?

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* 7. Does your district have a Workforce Wellness Committee?

Yes

Unsure

If "yes", please describe how often the team meets and the diversity of staffing. If "no", please share the plan to have this in place by September 30, 2023 (600 characters or less).

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* 8. Does your district implement MTSS as a framework for student academic or emotional support?

Yes

Unsure

Comments:

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* 9. Does your district formally gather staff input on policies and practices related to staff wellbeing?

Yes

Unsure

If yes, please describe frequency and tools used. If no, please describe barriers and plans to gather staff input for this project (600 characters or less):

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* 10. To what extent does your district partner with the following stakeholders to plan for and provide resources supporting positive working conditions?

	Monthly	Quarterly	Annually	As needed	Never	Unsure
Monthly Quarterly Annually As needed Never Unsure	Monthly Quarterly Annually As needed Never Unsure Monthly	Monthly Quarterly Annually As needed Never Unsure Quarterly	Monthly Quarterly Annually As needed Never Unsure Annually	Monthly Quarterly Annually As needed Never Unsure As needed	Monthly Quarterly Annually As needed Never Unsure Never	Monthly Quarterly Annually As needed Never Unsure Unsure
Comments (optional)
Certificated Staff	Certificated Staff Monthly	Certificated Staff Quarterly	Certificated Staff Annually	Certificated Staff As needed	Certificated Staff Never	Certificated Staff Unsure
Comments (optional)
Classified Staff	Classified Staff Monthly	Classified Staff Quarterly	Classified Staff Annually	Classified Staff As needed	Classified Staff Never	Classified Staff Unsure
Comments (optional)
Education Support Associates	Education Support Associates Monthly	Education Support Associates Quarterly	Education Support Associates Annually	Education Support Associates As needed	Education Support Associates Never	Education Support Associates Unsure
Comments (optional)
Local Education Association	Local Education Association Monthly	Local Education Association Quarterly	Local Education Association Annually	Local Education Association As needed	Local Education Association Never	Local Education Association Unsure
Comments (optional)
Educational Service District	Educational Service District Monthly	Educational Service District Quarterly	Educational Service District Annually	Educational Service District As needed	Educational Service District Never	Educational Service District Unsure
Comments (optional)
OSPI	OSPI Monthly	OSPI Quarterly	OSPI Annually	OSPI As needed	OSPI Never	OSPI Unsure
Comments (optional)
Health Care Authority (SEBB, SMART Health, etc)	Health Care Authority (SEBB, SMART Health, etc) Monthly	Health Care Authority (SEBB, SMART Health, etc) Quarterly	Health Care Authority (SEBB, SMART Health, etc) Annually	Health Care Authority (SEBB, SMART Health, etc) As needed	Health Care Authority (SEBB, SMART Health, etc) Never	Health Care Authority (SEBB, SMART Health, etc) Unsure
Comments (optional)
Health Plans (includes Kaiser Permanente)	Health Plans (includes Kaiser Permanente) Monthly	Health Plans (includes Kaiser Permanente) Quarterly	Health Plans (includes Kaiser Permanente) Annually	Health Plans (includes Kaiser Permanente) As needed	Health Plans (includes Kaiser Permanente) Never	Health Plans (includes Kaiser Permanente) Unsure
Comments (optional)
Employee Assistance Program	Employee Assistance Program Monthly	Employee Assistance Program Quarterly	Employee Assistance Program Annually	Employee Assistance Program As needed	Employee Assistance Program Never	Employee Assistance Program Unsure
Comments (optional)
Community Organizations	Community Organizations Monthly	Community Organizations Quarterly	Community Organizations Annually	Community Organizations As needed	Community Organizations Never	Community Organizations Unsure
Comments (optional)
Alliance for a Healthier Generation	Alliance for a Healthier Generation Monthly	Alliance for a Healthier Generation Quarterly	Alliance for a Healthier Generation Annually	Alliance for a Healthier Generation As needed	Alliance for a Healthier Generation Never	Alliance for a Healthier Generation Unsure
Comments (optional)
Parent Teacher Association, Booster Clubs or other school/district affiliated groups	Parent Teacher Association, Booster Clubs or other school/district affiliated groups Monthly	Parent Teacher Association, Booster Clubs or other school/district affiliated groups Quarterly	Parent Teacher Association, Booster Clubs or other school/district affiliated groups Annually	Parent Teacher Association, Booster Clubs or other school/district affiliated groups As needed	Parent Teacher Association, Booster Clubs or other school/district affiliated groups Never	Parent Teacher Association, Booster Clubs or other school/district affiliated groups Unsure
Comments (optional)

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* 11. In 1200 characters or less, please share the nature of any partnerships and/or plans to do so:

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* 12. What challenges do you anticipate in being able to meet the expectations and desired outcomes of the COP? Consider the following: Establishing a district level K-12 workforce wellness team by 9/30/23, prioritizing regular attendance at cohort sessions, completing team-based homework between sessions, completing the WA Workforce Secondary Traumatic Stress Assessment or the Cultivating Staff Wellbeing Assessment (each is about 14 questions) by the November session, applying a MTSS framework to staff wellbeing.

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* 13. What policies do you have in place to support staff wellbeing?

WSSDA Model policy 5515: Workforce Secondary Traumatic Stress

Staff Wellbeing is included in our district strategic plan

At least one school in our district includes staff wellbeing as part of their School Improvement Plan

Other (please specify)

	Morning (9:00-11:00 window)	Mid day (11:00-3:00 window)	Afternoon (3:00-5:00 window)
Monday	Monday Morning (9:00-11:00 window)	Monday Mid day (11:00-3:00 window)	Monday Afternoon (3:00-5:00 window)
Tuesday	Tuesday Morning (9:00-11:00 window)	Tuesday Mid day (11:00-3:00 window)	Tuesday Afternoon (3:00-5:00 window)
Wednesday	Wednesday Morning (9:00-11:00 window)	Wednesday Mid day (11:00-3:00 window)	Wednesday Afternoon (3:00-5:00 window)
Thursday	Thursday Morning (9:00-11:00 window)	Thursday Mid day (11:00-3:00 window)	Thursday Afternoon (3:00-5:00 window)
Friday	Friday Morning (9:00-11:00 window)	Friday Mid day (11:00-3:00 window)	Friday Afternoon (3:00-5:00 window)

Application for MTSS for Staff Wellbeing Learning Cohort 2023-24

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* 1. Contact information:

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* 2. District Low Income Rate

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* 3. Employee Demographics (approximate is OK)

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* 4. Is there any additional information you'd like to share about the data entered in the racial breakdown of your staff teams?

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* 5. Why is your district interested in joining this cohort?

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* 6. How would you describe the buy-in or support of your district administrators for your participation in this cohort and/or workforce wellness efforts?

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* 7. Does your district have a Workforce Wellness Committee?

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* 8. Does your district implement MTSS as a framework for student academic or emotional support?

Question Title

* 9. Does your district formally gather staff input on policies and practices related to staff wellbeing?

Question Title

* 10. To what extent does your district partner with the following stakeholders to plan for and provide resources supporting positive working conditions?

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* 11. In 1200 characters or less, please share the nature of any partnerships and/or plans to do so:

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* 13. What policies do you have in place to support staff wellbeing?

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* 14. If selected to be part of cohort 2, please select any days or times of the week that will NOT work for the key members of your district staff wellbeing team to join a session? (Note, this question will not be scored as part of the application)