About the Program: The 21st Century Learning Exemplar Program is designed to be a cornerstone for the next stage of the 21st century skills movement. For the past 12 years P21 has advocated for 21st century readiness for every student. Thousands of schools, communities, and thought leaders across the country have helped to define 21st century skills and promote their adoption. Now, we are ready to lead a coalition of educators and partners in identifying what 21st century educational practices look like and where they are being implemented successfully. Through the Exemplar Program, P21 seeks to identify, document, promote, and celebrate examples of successful 21st century learning. This program will provide educators and communities with a variety of examples to draw from, and offer policymakers and P21 State Partners local examples to help encourage their support. Application Process: All schools and districts based in the U.S. are eligible to apply. After you submit your application, you will receive automatic notification via email of your submission. You will be notified by email of the status of your application. Schools that have been selected for an evaluative visit will be contacted and additional materials or information may be requested in advance of that visit. Evaluative visits will be conducted in the Spring and Fall. Scheduling will be individually determined based on P21 and school representative availability. Following the evaluative visits, the evaluation team will make a determination regarding 21st Century Learning Exemplar status. Completing the Application: Each school will be asked to provide basic information and school demographic information as part of the application process. This information will be submitted through an online form. You will also need to complete this self-assessment and include it as an attachment to the online form. Additionally, schools may attach up to six (6) additional supporting documents through the online application form. All additional attachments should total no more than 30 pages cumulatively. The self-assessment component of this application is broken down into seven (7) sections. For sections 1-6, you will indicate your school’s level of engagement (if applicable). Using the pull down menu, please indicate whether the area falls under one of the following: Not a Focus in Our School Planning to Address Initial or Partial Implementation Full Implementation For each area you are implementing, please briefly describe each activity and identify any outcomes or evidence that supports your assertions. Please observe the text limits. Thank you! 1 Massachusetts Avenue NW, Suite 700 ▪ Washington, DC 20001 (202) 312-6429 ▪ Web: www.p21.org Early Learning Exemplar School Application - Self-Assessment School Name: pg. 2 Section 1: Commitment to Learning and School Readiness Descriptors Meets the National Institute for Early Education Research (NIEER) quality measures (cognitive development, social/emotional health, executive function development) Choose an item Partnerships with postsecondary institutions have contributed to capacity building Choose an item Partnerships with local/regional agencies and businesses have contributed to capacity building Choose an item Measure and collect data for school and life readiness (cognitive, physical, social/emotional, executive function, and P21 skills development) Choose an item Please describe implementation activities and any outcome data or examples (limit 600 words / 4000 characters): Enter your text here Questions may be directed to Tatyana Warrick by phone at (202) 312-6429 or email at tatyana@p21.org Early Learning Exemplar School Application - Self-Assessment School Name: pg. 3 Section 2: Education Support Systems and Intentional Design Descriptors Standards, milestones, and curriculum aligned to learning/school readiness Choose an item Instructional systems support cognitive, physical, social/emotional, executive function, and P21 skills development Choose an item Measures of assessment (formative, summative, performancebased/observational) support cognitive, physical, social/emotional, executive function, and P21 skills development Choose an item Learning environments support cognitive, physical, social/emotional, executive function, and P21 skills development (learning through play/integrated learning) Choose an item Please describe implementation activities and any outcome data or examples (limit 600 words / 4000 characters ): Enter your text here Questions may be directed to Tatyana Warrick by phone at (202) 312-6429 or email at tatyana@p21.org Early Learning Exemplar School Application - Self-Assessment School Name: pg. 4 Section 3: Education Support Systems and Intentional Design Descriptors Project-based learning approaches and facilitation of learning through play are utilized regularly Choose an item Inquiry-based instructional activities are utilized regularly Choose an item Comprehensive and individualized curriculum is supportive of cognitive, physical, social/emotional, executive function, and P21 skills development Choose an item Administrators, educators, and staff have expertise to support learning vision Choose an item Please describe implementation activities and any outcome data or examples (limit 600 words / 4000 characters): Enter your text here Questions may be directed to Tatyana Warrick by phone at (202) 312-6429 or email at tatyana@p21.org Early Learning Exemplar School Application - Self-Assessment School Name: pg. 5 Section 4: Equitable Student Access to 21st Century Learning Descriptors All students benefit from program and services provided Choose an item Strategies exist for integrating parents and families Choose an item Preschool activities are extended into students’ homes Choose an item Please describe implementation activities and any outcome data or examples (limit 600 words / 4000 characters): Enter your text here Questions may be directed to Tatyana Warrick by phone at (202) 312-6429 or email at tatyana@p21.org Early Learning Exemplar School Application - Self-Assessment School Name: pg. 6 Section 5: Student Acquisition of 21st Century Knowledge and Skills Descriptors There is evidence of student cognitive, physical, social/emotional, executive function, and P21 skills development Choose an item There is evidence of student inquiry and motivation to utilize new tools and skills for learning Choose an item There is evidence of student interest in using media and technology skills for learning Choose an item Please describe implementation activities and any outcome data or examples (limit 600 words / 4000 characters): Enter your text here Questions may be directed to Tatyana Warrick by phone at (202) 312-6429 or email at tatyana@p21.org Early Learning Exemplar School Application - Self-Assessment School Name: pg. 7 Section 6: Partnerships for Sustainable Success Descriptors Parents and families partner with your school to substantively contribute to student success Choose an item Community partners (including ‘Beyond School’ partners) contribute to your school’s successful outcomes Choose an item Postsecondary partners contribute to your school’s sustainable success Choose an item Civic leaders contribute to your school’s sustainable success Choose an item Family and student service providers contribute to your school’s sustainable success Choose an item Policymakers contribute to your school’s sustainable success Choose an item Please describe implementation activities and any outcome data or examples (limit 600 words / 4000 characters): Enter your text here Questions may be directed to Tatyana Warrick by phone at (202) 312-6429 or email at tatyana@p21.org Early Learning Exemplar School Application - Self-Assessment School Name: pg. 8 Final Statement: Please share any additional information regarding your school and its emphasis on 21st century learning and skills development (limit 600 words / 4000 characters): Enter your text here Questions may be directed to Tatyana Warrick by phone at (202) 312-6429 or email at tatyana@p21.org