Please use this form to select one option in each category of activities (teacher evaluation and Common Core State Standards implementation) your district intends to implement in 2013-14 for the supplemental scope of work fund. Districts will have an opportunity to revise these options prior to finalizing their commitment.

Please note that the student assignment options are not listed on this form; districts will be asked to select a student assignment option later in the year since they will be implemented in 2014-15.

Please complete and submit this form by Tuesday, July 23, 2013.

For questions and support, please contact

* 1. District Name

* 2. District Contact Person (name)

* 3. Email Address of District Contact Person

* 4. Teacher Evaluation (implementation in 2013-14) (SELECT ONE)

* 5. Common Core State Standards Implementation (implementation in 2013-14) (SELECT ONE)