2017-2018 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 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:

Special Education Leader/Director

CVTE Leader/Director

Administrative Academic/Curriculum Director

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 (July 12-13, August 22-23, and October 19, 2017; and January 24, and April 11-12, 2018)* 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.
*All participants must stay overnight at Devens Center in Devens, Massachusetts on the nights of July 12, and August 22, 2017; and April 11, 2018. 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 (July 11, August 21, and October 18, 2017; and January 23 and April 10, 2018). The cost of the hotel room will be covered for these nights as well; participants will be responsible for all other travel costs.

Three graduate-level college credits are available from Framingham State to participants completing the institute and requirements. The individual participant must pay for any and all costs associated with earning graduate credit.

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.