CRANE Professional Development Application for Educators December 2019

Please make sure to carefully read the instructions at the bottom of the form.

Charles Crane Family Foundation
Due Date: December 19, 2019

1Teacher Application > 2Principal Signature
Applicant Name: Applicant Name: First Last
Email:
Phone Phone - ### - ### ####
Name of School

If your school is not listed, please contact Terri Rosen - tnrosen@cjebaltimore.org
School Type
Are you a teacher?
Grade(s) & subject(s) you teach:
# of years teaching in current school
# of years in Jewish education
Are you a principal?
# of years in Jewish Educational Administration
# of years in current school
Not a teacher or principal? Please indicate your position:
What Professional Development Program did you attend?
Location of Program:

City and state
Is this an application for reimbursement for the Torah U'Mesorah Convention?

Is this an application for reimbursement for the Torah U'Mesorah Convention? yes no
Subject matter of this professional development opportunity. Select all that apply.

Subject matter of this professional development opportunity. Select all that apply. Working towards College Degree New School Year/Orientation Special Education Early Childhood Education Curriculum Development/Classroom Management Pedagogical Strategies Other Other
Dates of Program

include year
Were meals provided as part of the professional development program?

Were meals provided as part of the professional development program? Yes No
Cost of Program $ Dollars . Cents
We can only reimburse those costs for which you provide receipts. This includes transportation and other related costs.
Did you receive other funding for this program?

Did you receive other funding for this program? Yes No
If yes, how much?
Organization you received funds from:
This program:

This program: Did not meet my expectations Met my expectations Exceeded my expectations

Please indicate how strongly you agree with the following statements:
	Strongly Agree	Agree	Disagree	Strongly Disagree
This program positively influenced my teaching practice	This program positively influenced my teaching practiceStrongly Agree	This program positively influenced my teaching practiceAgree	This program positively influenced my teaching practiceDisagree	This program positively influenced my teaching practiceStrongly Disagree

Describe one new technique that you have applied in your classroom as a result of participation in this program.

Please indicate how strongly you agree with the following statements:
	Strongly Agree	Agree	Disagree	Strongly Disagree
My student/s showed a change in performance, attitude or skills as a result of this professional development training	My student/s showed a change in performance, attitude or skills as a result of this professional development trainingStrongly Agree	My student/s showed a change in performance, attitude or skills as a result of this professional development trainingAgree	My student/s showed a change in performance, attitude or skills as a result of this professional development trainingDisagree	My student/s showed a change in performance, attitude or skills as a result of this professional development trainingStrongly Disagree

Please provide a brief example of how your student/s showed a change in performance, attitude or skills as a result of this professional development training.
Will you have the opportunity to share your experience with other educators in your school (formally or informally)?
You have the option to upload program description, proof of payment, and proof of program completion here.

Attach Files

You will still need to submit these documents to your principal separately.
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Signed Date Signed / MM / DD YYYY
STOP! Please read carefully.

Educators: Check the box below marked “save my progress and resume later.” You will be prompted for an email address. If you are not ready to submit to the principal, then enter your email here. When you are ready to submit for review, enter your principal’s email address at the prompt and then hit the “Save form and Resume Later” button. Your application will automatically be forwarded to your principal for signature and upon his/her completion you will receive a receipt that your application was submitted. If you do not receive an email confirmation, please reach out to your principal to ensure completion.

Principals: On the next page you will need to enter the amount to recommend for reimbursement, so be sure to calculate that amount from the total entered above. Then click on "Continue" in order to verify this application and submit your signature.
Save my progress and resume later
Enter Your Email Address *

A special link to resume the form will be sent to your email address.

CRANE Professional Development Application for Educators December 2019

CRANE Professional Development Application for Educators December 2019

STOP! Please read carefully.