Instructional Coach Application & Letter of Commitment 2015-2016
Application Deadline: August 15, 2015
DO NOT LEAVE ANY ITEMS BLANK
Personal Information:
1. Name:
Last
First
Middle
Preferred Nickname
SSN:
Social Security Number (you are required to provide a social security number on your application
pursuant to 42 USC §666 and California Family Code §17520. The SSN will be used to confirm
your credential status and eligibility for BTSA Induction. It will only be entered on a encrypted site
to protect your information.)
DOB:
Month
Day
Year
State
ZIP
2. Mailing Address:
Street Address
Street Address
City
3. Contact Information:
Home Phone:
Work Phone:
Mobile Phone:
Other Phone/Fax:
Email (preferred):
Email (alternate):
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Personal Information Continued:
4. School of Employment:
5. Gender:
Male
Female
6. Ethnicity:
African American or Black
Asian American/Asian/Indian (e.g. Chinese, Japanese)
Latin American, Puerto Rican, Mexican American, Chicano or other Hispanic
South East Asian American/South East Asian (e.g. Cambodian, Hmong)
Pacific Islander, Filipino
Caucasian (non-Hispanic)
Native American/Alaskan Native
Other (Please Specify):
Please Note: these are the categories required by the Department of Education. Mark all that
apply The Reach Institute for School Leadership affords equal opportunity to all students, and
other participants without regard to race, color, religion, citizenship, political activity or
affiliation, marital status, age, national origin, ancestry, physical or mental disability, medical
condition (as defined under California law), veteran status, family care status, sexual orientation,
sex (which includes gender and gender identity, pregnancy, childbirth, or related medical
conditions), taking or requesting statutorily protected leave, or any other basis protected by law.
Responsibilities as a Reach Instructional Coach:
o Participating Teacher’s Formative Assessment includes the following:
 Develop a trusting and reflective professional partnership with Participating Teacher(s).
 3–5 hours with each participating teacher before school starts to assist with classroom set up
and planning.
 Assist Participating Teachers to develop an Individual Learning Plan based on The
California Standards for the Teaching Profession and their school site goals. Support the
teachers in making periodic adjustments based on feedback from formative assessments and
similar sources. Ensure Participating Teacher develops and completes a professional
development plan, based on the Individual Learning Plan.
 Ensure the Participating Teacher completes the requirements of the program, generating
evidence of reflection on practice sufficient to demonstrate deep and meaningful formative
assessment.
 Provide weekly, on-site support to each Participating Teacher (averaging approximately 1.5
hours each week, with the ability to vary group meetings, observations, and one-on-one
meetings tailored to the needs of the Participating Teacher).
 Model/teach a lesson or lessons for each teacher you are supporting as appropriate.
 Co-plan, participate in, and facilitate support and training activities for Participating
Teachers (including monthly collaborative group meetings if appropriate). May also
include: release-day workshops, veteran teacher observations, and an end-of-year
celebration/colloquium.
 Assist each Participating Teacher in developing and maintaining documentation of formative
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
assessment processes to be used as evidence of the teacher’s professional growth activities.
Assist each Participating Teacher in compiling and submitting the required portfolio.
o Coach Professional Development, including participation in:
• A coach orientation: choose one date (August 11th, 20th, 27th, or September 8th)
• Reach facilitated Instructional Coach trainings:
o Minimum year 1 training: Instructional Coaching consists of 4 x 3 hour workshops with
job embedded inquiry and online collaboration offered in September-October 2015.
o Minimum year 2 training: Coaching for Equity consists of 4 x 3 hour workshops with
job embedded inquiry and online collaboration offered in January-February 2016 (may
be completed in the first year or second year of coaching.)
• Fall Coaching Forums: choose one date (TBD)
• Spring Coaching Forum: choose one date (TBD)
• Coach Formative Assessment process based on a personalized Professional Development
Plan (PDP).
• Portfolio Scoring Session in the Fall: choose one date (January 27th, 28th, or February 3rd)
• Portfolio Scoring Session in the Spring: choose one date (May 26th, June 1st, or 2nd)
• Review your Participating Teachers’ eligibility for BTSA; monitor and support noncredentialed teachers on your caseload (if any) in their progress towards full credentialing;
refer PT to Reach Program credential analyst for specific information if necessary.
• Submit a monthly meeting log documenting contacts with your Participating Teacher(s).
• Uphold the Reach confidentiality agreement with the Participating Teacher.
• Coordinate a meeting, once annually, with yourself, your participating teacher, and the
participating teacher’s site administrator to discuss learning goals and progress.
• Coordinate with other teacher training/development programs within the Reach Program or
in your school, e.g., Intern Program, professional development program, etc. as necessary.
• Participate in the program evaluation process (Mid-Year Survey) and comply with district
and project reporting procedures (BTSA Consent Form and Statewide Survey)
Technology Agreement
The Reach program includes online tools and a digital portfolio requirement. Coaches are
responsible for accessing sufficient technology to support Participating Teachers. In order to do this,
Coaches will need to:
• Maintain working access to a computer, sufficient to complete online formative assessment
documents: high-speed internet access, reliable email access, and software applications
including MS Word and MS Powerpoint.
• Maintain access to a scanner (either personal, school, or at library or retail location).
• Support the PT to maintain and submit digital evidence of Formative Assessment Work.
• Either use a laptop for note taking in one-on-one meetings (recommended) OR scan/digitize
formative assessment materials generated in meetings in a timely fashion following
meetings.
• Backup all Reach related files.
Media Release
I give my permission to the Reach Institute for School Leadership (“Reach”) to use audio/video
recordings of my image, voice, and/or written materials submitted created through my
participation in any Reach program in any manner or form for any lawful purpose at any time.
The rights herein granted shall include the right to edit any of my statements or work for comments
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and portions of the same in such a manner as Reach may determine. All portions of the production
and juxtapositions of audio/video recordings and other material shall be to the discretion of Reach.
Further, Reach shall have the right to distribute, exhibit or otherwise use this material in whole or in
part and in any medium, by means of television, videodisc, or otherwise.
I hereby release and discharge Reach from any and all liability arising out of any injury of any kind
that may be sustained by me from participating in or in connection with making or utilization of the
material.
If, at the discretion of Reach, participants’ names are included in any credits, I want my name to
appear in the credits as shown below.
Coach Affirmation and Signature
I have read the Coach Responsibilities described above and agree to follow them to the best of my
ability. I understand that I am responsible for fulfilling all Coach requirements, including
attendance at Coach Forums and trainings and completion of documentation required by the
program pursuant to the growth and participation of Participating Teachers.
I certify that I posses a valid California Professional Clear Teaching Credential.
I agree to respond to official requests for information from the program leaders and administrative
staff of the Reach Induction Program and from representatives of the California Department of
Education and the California Commission on Teacher Credentialing who have responsibility for
induction program reviews and evaluation.
I have read and understood the instructions, information and expectations given to me in
this document, and I wish to participate in the Reach Professional Teacher Induction Program
(BTSA) as a Participating Teacher Instructional Coach.
Coach Name
(Please Print):
__
Coach’s Signature:
___________________________________ Date: __
__________________________________________________
_________
Upon completion of this Letter of Commitment,
please return a copy by fax or email (scanned with signature) to:
Reach Institute for School Leadership
ATTN: Induction Program
Fax (510) 868-2215
info@reachinst.org
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