Professional Learning Community (PLC) for After School Practitioners Group 2

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* 1. Your Name

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* 2. Name of your school or organization

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* 3. School/Organization address

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* 4. County

Hudson

Bergen

Passaic

Essex

Somerset

Middlesex

Mercer

Other (please specify)

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* 5. Best Email Address to reach you directly

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* 6. Best phone number to reach you directly

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* 7. Is your program

Stand-alone non-profit, private organization (i.e. Boys' and Girls' Club at a center, YMCA on site)

School-based program (Run by the school district at the school)

Non-profit private organization operating as a 3rd party (i.e. Boys' and Girls' Club program run at a school or offsite)

Other (please specify)

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* 8. Current position or title

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* 9. Describe what you do in your position.

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* 10. What grade or age group do you primarily work with?

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* 11. Do you currently use the outdoors for LEARNING?

Yes

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* 12. If you answered "yes": What activities do you currently do outside?

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* 13. If you answered "no": Why not?

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* 14. Without using the words: "Science, Technology, Engineering or Math", describe what STEM means to you.

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* 15. What are some personal or institutional challenges in implementing STEM in your program?

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* 16. We encourage teams of 3 or more to apply for this opportunity. Are you applying as a team?

Yes

I don't know

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* 17. What days and times work best for Professional Development?

Weekday Daytime (9am to 2pm)

Weekday Evening (4pm to 9pm)

Saturday Daytime (10 am to 3pm)

Other (please specify)