APPLICATION FOR PROFESSIONAL DEVELOPMENT
DISTRICT LEVEL TRAINING 2007


PDA LOGO

title

 


Recipients of the training are expected to work with others in their district to use the training to build sustainable capacity within and across programs. Commitment includes time for planning, travel, funds, relief time for staff to attend training and commitment to implementation. This training is designed for teams from districts who will be involved in providing direct services to students with and/or training others in the district. This training is not designed for novices in the area of working with students with ASD, but rather for people looking to expand their knowledge and skills in the area of ASD. Team members participating in this training will assist their district in improving their capacity to serve students with ASD through training and direct service. Teams should consist of at least 6-8 members.

 

Date:
School District:
State:
Special Education Director:
District Contact Person:
Title:
Email:
Address:
Phone:
District Type:
Number of Students Served:
% of Students with Free or Reduced Lunch:

DEMOGRAPHIC INFORMATION
To facilitate the application process you may send Demographic Information separately as long as you provide the School District and District Contact Person again. You must still type in the Acces Code at the bottom of the page to submit the info but can leave all other fields blank.
% American Indian:
% Asian/Pacific Islander:
% Black:
% Hispanic:
% White:
% Other:
% of Students with ASD Label:
% of Students with IEPs:

 

 

 



This training requires a commitment from the appropriate school district supervisory personnel (e.g. assistant superintendent, special education director) who can commit time for planning, travel, commitment to implementation, funds and relief time for staff to attend training. Who in the district office should we contact to confirm their commitment?

Name:
Position:
Phone:
Email:

 



 

Current Services:

 

 

Program Vision and Philosophy:

 

Please describe how you view students with ASD as part of your total school population:

 

District Level Training Requested:

 

Please describe what you would like to accomplish with this training:

Have you worked with a PDA center previously? If so please describe:


DISTRICT LEVEL PARTICIPANTS
Please indicate which members will become district trainers

Name
Title
District Trainer Y/N?


SCHOOL/SITE BASED PARTICIPANTS

Name
Title
School/Site



For security purposes please type in the letters (all capitals please) into the form field below before submitting:

 

Please contact the administrator if you cannot read this.