1. MLTI Consultative Model

Please complete the following form if you are interested in taking part in the MLTI Consultative Model of Professional Development.

If you have any questions, please contact Juanita Dickson at juanita.dickson@maine.gov.

* 1. Requestor Information:

* 3. Please complete the following. If you are the principal, please enter "same as above" in the boxes.

* 4. Is your school interested in participating in the in-depth research program?

* 5. Why does does your school want to work with MLTI in the consultative model for professional development?

* 6. What percentage of the school's teachers would be committed to working with the MLTI professional development team?

* 7. Please list the number of teachers by content area and include grade spans taught and the curricular focus for those teachers (ie what specific area will the professional development focus?). For example: Mathematics: 3 teachers, all teach 7-8, focus on understanding data representations.

* 8. Please list the members of your schools leadership team that will consult with the MLTI professional development team. Include why each member is important to the team.