Thank you for being an innovative educator in Palm Beach County Schools and for applying to the Innovative Educator Contest ! We recommend that you complete all of your responses in THIS WORKSHEET, and then copy and paste your answers into the fields on the web-based application form.
When you submit your form, you will be automatically redirected to a page with a link to the File Uploader. You will use the File
Uploader to send your supplemental resources to us for evaluation. You can include up to four additional resources used in this project. These might include project rubrics, pictures, video, or student work samples, among other items, that would provide additional insight on the project and its results. Your additional resources can be documents, presentations, music, and/or videos.If you are including videos, please upload them to the Vodcast Server before completing this application. You will need to enter the
URL to your video(s) in the application.Note: if your resources include student work, student images, or student voices, you must include a signed 1941 form for each student. The 1941 forms do not count toward your four additional resources.
Personal Information
Contact Information
First Name
Last Name
Home Address Line 1
City
Home Address Line 2

Zip
State
Primary Phone Number
Work Email Address
Project Information
What is the title of your learning activity? (HINT: Give your learning activity a catchy title.)
Choose one or more grade level. o Elementary School o
Middle School o High School o Adult Education (Not Professional Development)
Subject(s) (These must be part of your learning goals.)

What is the duration of your learning activity? o One Week o 2 - 3 Weeks o 4 - 6 Weeks o One Marking Period o Ongoing o Other
Technologies UsedCertain restrictions apply: In order to receive one of the Microsoft awards, one or more of the Microsoft technologies must have been used in a significant way in your learning activity.
What software was used in your learning activity? o Adobe Illustrator o Adobe Photoshop o Aperture o
AutoCollage o Bing Translator o CrazyTalk o Deep Zoom o
Evernote o FaceTime o Flashcards by Microsoft o Garageband o iBooks Author o iMovie o Inspiration o Keynote o
Kidspiration o Kinect for Windows SDK o Kodu o Logic Pro o
MainStage o Math Worksheet Generator o Microsoft Access o Microsoft Chemistry Add-in for Word o
Microsoft Excel o Microsoft Mathematics 4.0 o Microsoft Mathematics Add-in for Word o Microsoft Mouse Mischief o
Microsoft Office Ribbon Hero o Microsoft PowerPoint o Microsoft Publisher o Microsoft web and/or software development tools (e.g., Visual Studio, Expressions, XNA Gaming Studio, Kinect SDK, etc.) o
Microsoft Word o Microsoft Worldwide Telescope o Microsoft Paint o Motion o
Numbers o Pages o Photo Booth o Photo Story 3 o
Photosynth o QuickTime Player o Reflector o Skype

o Small Basic o TouchDevelop o
Windows Live Photo Gallery o Windows MovieMaker o None o Other
What hardware was used? o
Windows desktops o Apple desktops o Windows laptops o Apple laptops o iPad o Kinect o None o Other
STRUCTURE OF THE PROJECT
What are your objectives and learning outcomes? What are your students expected to know and/or do at the end of this learning activity?
EVIDENCE OF LEARNING
To what extent do your student samples demonstrate the different dimensions of 21st century skills? Describe and provide supporting details.

COLLABORATION (For an understanding of how “Collaboration” is defined and measured for the purpose of this competition, please refer to the Rubric Companion.)
To what extent does your learning activity require students to collaborate and negotiate with other people to make substantial decisions that shape the content, process, or produce of their work? Describe and provide supporting details and examples.
KNOWLEDGE BUILDING (For an understanding of how “Knowledge Building” is defined and measured for the purpose of this competition, please refer to the Rubric Companion.)
To what extent does your learning activity stimulate students to build knowledge? Is the knowledge you are requiring students to build cross disciplinary?
REAL-WORLD PROBLEM SOLVING AND INNOVATION
To what extent does the learning activity require problem solving based on authentic situations and data from outside the classroom, and are students’ solutions implemented in the real world? Be sure to describe in detail and provide specific supporting examples.
USE OF TECHNOLOGY
To what extent does this learning activity rely on the use of technology? (For example, projecting teacher’s writing on a screen for all to see is nice, but can also be accomplished by writing on a white board, chart paper, or other method that does not require technology.
Students creating book reports in PowerPoint can also be done on paper, in a diorama, poster board, etc. The key point here is that in order to be considered “innovative,” the technology must be used in such a way that the learning activity would not be possible without it.)

TEACHER AS INNOVATIVE EDUCATOR AND CHANGE AGENT
Describe how you have significantly changed the learning process through the use of technology integration for learning. Be specific and include examples from your learning activity.
Implementation Outline ~ List the steps required to implement the learning activity.
Implementation Tips ~ Offer suggestions to others that may help them implement this type of learning activity.
Lessons Learned ~ Explain how this learning activity could be improved.
Standards ~ List two or three of the most significant Sunshine State Standards or Common Core Standards (please write out the entire standard not just a number) AND International Society for Technology in Education [ISTE] NETS Standards that are addressed through this learning activity.
Assessment Strategies ~ List the strategies used to assess student learning.

Student Products ~ Describe the products and/or performances created by students for this learning activity.
Evidence of Learning ~ Provide evidence that the learning goals of this activity were met.
Supplemental Materials
If you uploaded any videos to the Vodcast Server, please paste the link(s) below. NOTE: Each video counts as one resource. You may only submit up to four resources total. All student work, vocals, or images must have a 1941 form.
Do any of your resources include student work, student images, or students’ voices? If yes, Release and Consent for Student
Information Publication forms (PBSD 1941) is required for all students whose images, writing, or voice recordings are in your projects. These forms should be scanned, in alphabetical order, into a single PDF document, with each page being clearly readable and having the same orientation (portrait, right-side up). Please use the following naming convention, replacing my first initial and last name with yours, to name your file: Release & Consent Forms - J Shoemaker.pdf This file does not count toward your four resource limit. You can easily scan a multiple page document and send it to your email with the new Ricoh copiers. Please ask if you need assistance. o Yes o No
When you click Submit below, you will be redirected to a page with the link to the SDPBC File Uploader. Click the link and log in with your District credentials. Once you are logged in, select Upload. Find the file on your hard drive, select it, and click upload.
Continue this process for each of your resource files. You may include up to four resources with your application. (Remember, your
1941 forms do not count toward your four resources.)Once your files have been uploaded, click next. On the TO screen, send your files to edtechmedia@palmbeachschools.org Dont forget to include your name in the message box so we know who you are! o
I understand