ISBE/ParenTeach High School Parenting Education Pilot

Demographics

This short list of questions helps us better understand your high school's current initiatives and desires for implementation during this pilot.

Question Title

* 1. Applying high school:

High School:

Address 1:

Address 2:

City/Town:

State:

ZIP/Postal Code:

County:

Point of Contact Name:

Point of Contact Email:

Point of Contact Phone Number:

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* 2. 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

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* 3. District and/or health/wellness division curriculum leaders will need to authorize the adoption of this 10-day evidence-based curriculum during the Fall and Spring semesters. Do you believe that the final authorizers will support your high school's participation?

Yes

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* 4. Have you identified and/or fully believe that you can coordinate with an existing high school health/wellness teacher to participate in both semesters during the school year that also complies with any of their union contracts or previous employment agreements with your district?

Yes

If yes, please specify the name of the proposed Health/Wellness teacher

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* 5. According to the Illinois Risk and Reach Report, what overall risk is the county where this High School is located?

Low

Low-Moderate

High-Moderate

High

No data

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* 6. Is there an evidence-based parenting education curriculum currently in place to fulfill HB 4442 in this school year?

Yes

If yes, please provide the name of the curriculum:

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* 7. What data are 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 HS:

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* 8. 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

Please list name and contact information for at least 3 community based mental health providers that your High School refers to:

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* 9. Below is a sample of how other high schools have informed parents of student participation in this Health and Wellness student learning requirement:

SAMPLE LETTER:

Is this something your high school would utilize as well, or would you prefer another method of informing parents about this program?

Yes

Another method

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* 10. 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, is there 1:1 capacity planned).

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* 11. 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 district will further agree that aggregated (non-identifying information) data can be shared by ParenTeach with evaluators. Which school administrator (please provide full name) is authorized to sign this type of memo of agreement?