ParentABLE Application Survey

Question Title

* High School Information

High School *

High School Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Country *

Question Title

* School Administrator Information
(ie. Principal, Dean, etc.)

Position/Title:

First Name:

Last Name:

Email Address:

Phone Number:

Question Title

* Teacher Information
(please list a primary teacher- others may be added at a later time)

Teacher First Name:

Teacher Last Name:

Teacher Email:

Teacher Phone Number:

Question Title

* Superintendent Information:

First Name:

Last Name:

Question Title

* Who will be our main point of contact at your school?

First Name:

Last Name:

Title:

Question Title

* Have you previously implemented the ParentABLE unit of curriculum?

Yes

Question Title

* How many teachers are going to participate from your school?

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* Are you going to teach ParentABLE yourself?

Question Title

* Approximately how many students would be included in ParentABLE at your school? (Total general number between all classes

Question Title

* What semester in the 2022-2023 academic school year are you aiming to implement ParentABLE?
(this will be clarified and confirmed at a later time)

Question Title

* I, as point of contact, agree to provide evidence that my high school administration, Board of Education, and participating teachers all have been notified (copy of emails is acceptable) that this ISBE pilot is voluntary and no information gathered can be used by ParenTeach, ISBE, nor the school for formal or informal evaluative data regarding student/teacher/ or school performance.

Yes

Question Title

* District and/or health/wellness division curriculum leaders will authorize the adoption of this 10-day evidence-based curriculum during the Fall (Oct. -Dec) and/or Spring (Mar.-Apr.) semesters.

Yes

Question Title

* Please state if ParentABLE will be taught in Health and Wellness, and if not, in what class it will be offered.

Yes

No (please specify)

Question Title

* According to the Illinois Risk and Reach Report, what overall risk score has the county been given where the applying high school is located?

Low

Low-Moderate

Moderate-High

High

Not sure

Question Title

* Is there an evidence-based parenting education curriculum currently in place to fulfill HB 4442 in the 2021-2022 school year?

Yes

Question Title

* What data is being gathered regarding your students' SEL competence and performance? (Check all that apply)

Annually (e.g. IL 5 ESSENTIALS or similar)

Formative (@unit, monthly, quarterly, semester levels)

None

Please describe additional SEL student initiatives currently in place at your high school.

Question Title

* How does your high school identify and address student mental health needs?

Refer internally to student services/dean

Refer externally to community mental health providers

Both internal and external supports provided

Unknown

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* Based on the e-learning design of this curriculum, please describe the current plans for student access to internet based learning (e.g. is high speed internet available to most, 1:1 capacity planned...).

Question Title

* This pilot will require a signed memo of agreement that details rights and responsibilities of participation, including authorized gathering of student and teacher participation data. The participating school/district will further agree that aggregated (non-identifying information) data can be shared by ParenTeach with evaluator- Harvard). Which school administrator (please provide full name, title, and email) is authorized to sign this memo of agreement?

First Name:

Last Name:

Title:

Email:

School Culture & Climate

Question Title

* Please upload a copy of your most recent Illinois Report Card.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

* Please upload a copy of your most recent School Culture and Climate annual student survey (IL5E or similar).

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

* In what current course curriculum (or student services programing e.g. SEL) and student year (FRESHMAN/SOPHOMORE/JUNIOR/SENIOR) has your high school supported student understanding around Adverse Childhood Experiences (ACEs)?

Question Title

* This pilot includes students' self-assessment of their own ACE scores without a requirement to share with others. Will your high school agree to include the ACE self assessment when implementing the ParentABLE curriculum?

Yes

Voluntary considerations for participation in parenting education pilot

Question Title

* Potential family engagement is possible with this student pilot that would offer parents of participating students a chance to discuss similar parenting topics during the same timeframe through a separate online access point. Would your school would be interested in this additional family engagement opportunity?

Yes

ParentABLE Application

Question Title

* High School Information

Question Title

* School Administrator Information (ie. Principal, Dean, etc.)

Question Title

* Teacher Information(please list a primary teacher- others may be added at a later time)

Question Title

* Superintendent Information:

Question Title

* Who will be our main point of contact at your school?

Question Title

* Have you previously implemented the ParentABLE unit of curriculum?

Question Title

* How many teachers are going to participate from your school?

Question Title

* Are you going to teach ParentABLE yourself?

Question Title

* Approximately how many students would be included in ParentABLE at your school? (Total general number between all classes

Question Title

* What semester in the 2022-2023 academic school year are you aiming to implement ParentABLE?(this will be clarified and confirmed at a later time)

Question Title

Question Title

* District and/or health/wellness division curriculum leaders will authorize the adoption of this 10-day evidence-based curriculum during the Fall (Oct. -Dec) and/or Spring (Mar.-Apr.) semesters.

Question Title

* Please state if ParentABLE will be taught in Health and Wellness, and if not, in what class it will be offered.

Question Title

* According to the Illinois Risk and Reach Report, what overall risk score has the county been given where the applying high school is located?

Question Title

* Is there an evidence-based parenting education curriculum currently in place to fulfill HB 4442 in the 2021-2022 school year?

Question Title

* What data is being gathered regarding your students' SEL competence and performance? (Check all that apply)

Question Title

* How does your high school identify and address student mental health needs?

Question Title

* Based on the e-learning design of this curriculum, please describe the current plans for student access to internet based learning (e.g. is high speed internet available to most, 1:1 capacity planned...).

Question Title

Question Title

* Please upload a copy of your most recent Illinois Report Card.

Question Title

* Please upload a copy of your most recent School Culture and Climate annual student survey (IL5E or similar).

Question Title

* In what current course curriculum (or student services programing e.g. SEL) and student year (FRESHMAN/SOPHOMORE/JUNIOR/SENIOR) has your high school supported student understanding around Adverse Childhood Experiences (ACEs)?

Question Title

* This pilot includes students' self-assessment of their own ACE scores without a requirement to share with others. Will your high school agree to include the ACE self assessment when implementing the ParentABLE curriculum?

Question Title

Question Title

* *Why are you interested in implementing ParentABLE?

* School Administrator Information
(ie. Principal, Dean, etc.)

* Teacher Information
(please list a primary teacher- others may be added at a later time)

* What semester in the 2022-2023 academic school year are you aiming to implement ParentABLE?
(this will be clarified and confirmed at a later time)