2016-2017 SPED/CVTE Leaders Academy Registration

1. SPED/CVTE Leaders Academy Registration

Thank you for applying to participate in the MA DESE's Special Ed./CVTE Leaders Academy provided by WestEd. For this academy, we require teams of 3 people from a single school or district - to participate together. Every person on your team will need to complete this registration survey. Also, you (and your team) will need to secure your Superintendent's permission to attend the academy. If you have questions, please contact Julie Colton or Colleen Abreu at 781.481.1100.

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* 1. Please enter your first name:

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* 2. Please enter your last name:

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* 3. Please tell us about your job. Are you a:

General Education Administrator

Special Education Administrator

CVTE Administrator

Comments:

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* 4. Please describe your leadership role:

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* 5. Please enter the name of your district / region:

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* 6. Please enter the name of your school:

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* 7. What type of CVTE program do you work with?

Regional vocational

Comprehensive/local (including city)

Academic regional

Agricultural

Collaborative

Other (please describe below)

Other:

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* 8. How many years have you been in your leadership position?

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* 9. Your work address:

Street address:

City:

Zip code:

Work email address:

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* 10. Your contact information:

Cell phone:

If you would like to be contacted at a different email address over the summer, please enter it here:

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* 11. Please check your agreement with the following:

I have discussed this opportunity with the Superintendent and have his/her support to attend the Academy if my application is accepted.

Other (please specify):

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* 12. Please type your name below to signify your acceptance of the following statement: I understand by submitting this application that I am making a commitment to attend all sessions of this academy (October 4-5, and November 9-10, 2016; and January 24-25, and April 12-13, 2017)* with my district/school team. In addition, I understand that my team and I are responsible for the design and implementation of a Capstone systems-change project as part of my participation in the academy. The academy sessions and materials will be provided at no cost to selected participants. Three graduate-level college credits may be available from Framingham State to participants completing the institute and requirements. The individual participant must pay for any costs associated with earning graduate credit.
*All participants must stay overnight at the Hilton Garden Inn in Devens, Massachusetts on the nights of October 4, and November 9, 2016 and January 24, and April 12, 2017. The cost of the hotel room will be covered for these nights; participants will be responsible for all other travel costs.
Participants may wish to stay overnight on the following dates which are prior to each session (October 3, and November 8, 2016 and January 23 and April 11, 2017). The cost of the hotel room will be covered for these nights as well; participants will be responsible for all other travel costs.
Please type your name below:

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* 13. If your team is accepted into the academy, we will send a letter to your superintendent confirming your participation. Please enter the name and work address of your superintendent:

Name of your superintendent:

Street Address of your superintendent:

City:

Zip:

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* 14. Please list the name(s) of the other people on your district/school team:

Name of other member of your district/school team:

Thank you again for applying to participate in the MA DESE's Special Ed/CVTE Leaders Academy provided by WestEd. Once your entire team has completed this registration form, we will let you know the status of your application. If you have questions, please contact Julie Colton or Colleen Abreu at 781.481.1100.