MDABESTRobotics Grant applictaion HEA LHTPD.pdf

MDA BEST Robotics Grant: Higher Education Agency (HEA) Local Hub Teacher Professional Development (LHTPD) 2017

Completed forms should be saved and submitted as FullUniversityName_MDABESTRoboticsGrant_HEA_LHTPD_2017. If there is any confusion, please refer to the actual grant for clarification.

1. Hub Information

a. DUNS Number:

b. Name: c. Physical Site/University Name:

d. Mailing Address:

City: State: ZIP Code:

2. Hub Director Information

a. Name:

b. Title or Position: c. Phone:

d. University or Organization: e. E-mail Address:

f. Mailing Address:

City: State: ZIP Code:

3. Hub Service Region information

Please enter the service regions and states that the hub supports up to 10 counties. If your hub supports less than 10 counties, you will not use all the space provided.

a. County b. State

4. Lead Teacher/Trainee Information (up to 10)

Please enter the lead teacher/trainee’s information, up to 10. If your HEA is proposing less than 10 lead teachers/trainees, you will not use all the space provided.

a. Name: b. Title or Position:

c. School or Organization: d. E-mail Address:

e. Grade Level Taught: f. First Year as Team Teacher:

g. Subjects Taught: h. Full-time Teacher: YES ☐ NO ☐

a. Name: b. Title or Position:

c. School or Organization: d. E-mail Address:

e. Grade Level Taught: f. First Year as Team Teacher:

g. Subjects Taught: h. Full-time Teacher: YES ☐ NO ☐

Approved for Public Release 17-MDA-9114 (29 March 17)

a. Name: b. Title or Position:

c. School or Organization: d. E-mail Address:

e. Grade Level Taught: f. First Year as Team Teacher:

g. Subjects Taught: h. Full-time Teacher: YES ☐ NO ☐

a. Name: b. Title or Position:

c. School or Organization: d. E-mail Address:

e. Grade Level Taught: f. First Year as Team Teacher:

g. Subjects Taught: h. Full-time Teacher: YES ☐ NO ☐

a. Name: b. Title or Position:

c. School or Organization: d. E-mail Address:

e. Grade Level Taught: f. First Year as Team Teacher:

g. Subjects Taught: h. Full-time Teacher: YES ☐ NO ☐

a. Name: b. Title or Position:

c. School or Organization: d. E-mail Address:

e. Grade Level Taught: f. First Year as Team Teacher:

g. Subjects Taught: h. Full-time Teacher: YES ☐ NO ☐

a. Name: b. Title or Position:

c. School or Organization: d. E-mail Address:

e. Grade Level Taught: f. First Year as Team Teacher:

g. Subjects Taught: h. Full-time Teacher: YES ☐ NO ☐

a. Name: b. Title or Position:

c. School or Organization: d. E-mail Address:

e. Grade Level Taught: f. First Year as Team Teacher:

g. Subjects Taught: h. Full-time Teacher: YES ☐ NO ☐

a. Name: b. Title or Position:

c. School or Organization: d. E-mail Address:

e. Grade Level Taught: f. First Year as Team Teacher:

g. Subjects Taught: h. Full-time Teacher: YES ☐ NO ☐

a. Name: b. Title or Position:

c. School or Organization: d. E-mail Address:

e. Grade Level Taught: f. First Year as Team Teacher:

g. Subjects Taught: h. Full-time Teacher: YES ☐ NO ☐

5. Training Information

a. Location: b. Date: c. Time(s):

d. Number of Learning Modules: e. Time for Each Module:

f. Briefly describe the learning objectives/modules. g. Briefly describe the learner’s assessments.

Please enter an itemized list of training materials including the cost per unit (teacher) and vendor. You may not use all the space provided.

h. Training Material(s) i. Cost per Unit j. Vendor

6. Competition Year 2016 Participant Information

Please enter number totals for the hub, and not for individual service regions.

a. Middle Schools: b. High Schools: c. Teams:

7. Projected Competition 2017 Information

a. Total Number of Teams: b. Requested Funding Amount:

ATTACHMENTS

When saving and submitting your attachments, please use the names listed below. Your attachments should be labeled with the appropriate attachment name and submitted with your application.

Attachment Name Description Submitted on Grants.gov

8. Teacher Professional Development Survey A hub-specific BEST Robotics teacher professional development survey

YES ☐

NO ☐

9. Support Letter 1 A signed support letter on official letterhead from the physical site’s senior leadership (internal), such as the University President or Vice-President

YES ☐

NO ☐

11. Teacher last name - Support Letter 2

A signed letter on official letterhead for each new teacher (up to 10 letters) to be trained, affirming that the teacher will have a BEST Robotics team and attend kick-off day training

YES ☐

NO ☐

12. Post-Award Agreement

A signed acknowledgement and agreement on official letterhead from the Hub Director to provide MDA STEM outreach with required post-award reporting, including but not limited to, demographic information, information briefs, videos, and/or photographs

YES ☐

NO ☐

13. SAM certification A certification that SAM information is current

YES ☐

NO ☐

14. WAWF certification A certification that a WAWF account is current

YES ☐

NO ☐

ATTACHMENTS