Collaborate 21 - School Team Application

School Information
School District:  
School Building:  
Team Members
Library Media Specialist:  
Classroom Teacher:  
Supervising Administrator:  
Technology Coordinator (optional):  
Demographic Information

(The terms of the Institute of Museum and Library Services grant which funds Collaborate 21 stipulate that teams from schools serving remote or underserved populations be given priority for participation. In the event that the number of applications exceeds the number of spaces available, this demographic information will be used to prioritize schools for participation in the program.)

Distance of the school from Fargo or Bismarck (whichever is closer): miles

Percentage of students who qualify for the free and reduced lunch program: %

Percentage of minority population in the school: %

Signature of Team Contact

In signing this application, the team contact is stating that all team members listed above have agreed to:

  • attend the Summer Training Academy June 9 - 11, 2014, at Valley City State University
  • participate in the online support activities during the 2014-15 school year,
  • collaborate to develop and implement an instructional project during the 2014-15 school year.

(Entering the following information online constitutes a signature)

Signed:  
Job Title:  
Email:   Phone:  
School address: