ATTACHMENT C
OFFICE OF SUPERINTENDENT OF PUBLIC INSTRUCTION
Old Capitol Building
PO Box 47200
Olympia, WA 98504-7200
2015–16 Title I, Part A Academic Achievement Award
APPLICATION
SCHOOL NAME
SCHOOL GRADE RANGE
SCHOOL DISTRICT
ADDRESS
SUPERINTENDENT
TELEPHONE
FAX
E-MAIL ADDRESS
CONTACT PERSON (TEAM LEADER)
TELEPHONE
FAX
E-MAIL ADDRESS
ADDRESS
PRINCIPAL
TELEPHONE
E-MAIL ADDRESS
BUSINESS MANAGER
TELEPHONE
E-MAIL ADDRESS
1.
What subject area is your team emphasizing? (If addressing both subject areas, complete a separate application
for each.)
Reading
and/or
Mathematics
2. Describe the leadership team in your school. (Use no more than two pages.)
3. Attach MSP/HSPE-Smarter Balance data showing consistent progress in student scores over the past three
years in the proposed subject area. (Use no more than two pages.)
4. Provide any other data to document improvement in student learning in the subject area you have selected.
Examples are district assessments, classroom-based assessments, or other assessment data. (Use no more
than three pages.)
5. Provide a chronological listing of how the school began its school improvement process, citing milestones,
community partners, and other important factors in the implementation of your strategy. Timeline chronology
should be consistent with the timeline of school improvement data and directly related to the subject area
emphasized. (Use no more than three pages.)
6. Describe how your school process addresses the Nine Characteristics of High Performing Schools. (Use no
more than three pages.)
7. Cite specific strategies and how they led to your school’s success in student achievement in the subject area
defined above and what you are doing to continue the trend. Address specific special populations and
demographics, effective instructional strategies and curriculum materials, professional development which made
a difference, and a specific school model, if used. (Use no more than three pages.)
8. Describe how the strategies described above could be replicated in other schools and district settings. (Use no
more than three pages.)
Signature of Superintendent or Designee
Date
Completed applications should be forwarded to:
Larry Fazzari, Program Supervisor, Title I, Part A/LAP
OSPI, PO Box 47200, Olympia, WA 98504-7200
Applications must be received by OSPI no later than November 30.
FORM SPI 1574 (Rev. 9/15)