Breakthrough Design Fellowship Application
Please use this form to apply for the Fall 2017 cohort of the CityBridge Breakthrough Design Fellowship.

Before applying, please:
1. review all of the program information at http://citybridge.org/fellowship/
2. talk about your interest with your principal

If you have questions, please reach out to Andrew Pratt: apratt@citybridge.org

About you
First name *
Your answer
Last name *
Your answer
Email *
Can be a work or personal email, but please ensure it's an account you check regularly.
Your answer
Personal phone number *
So that we can communicate with you about your application, if necessary.
Your answer
Role or position at your school *
Your answer
Grade(s) taught *
If you do not teach classes, please indicate the grade level(s) or ages of students you work with.
Your answer
Subjects(s) taught *
Your answer
What is something interesting we should know about you? *
(Who are you? What are you committed to, passionate about, dedicated to?)
Your answer
Your role in redesign
Your school has articulated a redesign vision as part of the Breakthrough Schools program. Please describe that redesign vision in your own words. *
Be as concise as possible, using 200 words or less.
Your answer
What role, if any, have you played in the school redesign work to date? *
Your answer
What role within your school do you want to play as part of future redesign work? *
Your answer
What work have you done or are you doing in your class or at your school that aligns with the following design principles: Intentional Equity, Deep & Personalize Learning, Expansive Measures? *
Your answer
Describe a specific equity challenge that your students face for which you would like to design an intentionally equitable solution. *
Be as concise as possible, using 200 words or less.
Your answer
Tell us about your work
What role do you play in your school community? Amongst faculty? Amongst students? Amongst parents/ local community? *
Be as concise as possible, using 200 words or less.
Your answer
In one sentence, tell us what you can uniquely contribute to the cohort of Breakthrough Design Fellows. *
Your answer
How do you assess the success of your teaching? *
Your answer
Tell us about your skills, will, and courage to lead for equity in your school. *
Your answer
How have you influenced the practice of other teachers in the past? Why do you want to learn more about how to expand that influence? *
Your answer
What brought you here?
What prompted you to apply to the Fellowship? *
Your answer
If you were referred by a specific person or persons, who was it? *
Your answer
Workshop dates & agreement
The CityBridge staff invests significant time and resources into fellows, and our expectation is that participants similarly invest their time, effort, and energy in order to get the most from the program.

If selected to join the Breakthrough Design Fellowship, you commit to:

- Attending all of the monthly program days (listed on the program overview page: http://citybridge.org/fellowship/)
- Completing all required assignments and readings
- Fully participating in collaborative learning teams outside of program days
- Maintaining regular contact with the CityBridge team for coaching and feedback

We will also host a welcome dinner for all selected Fellows during the first week of June (Wednesday, 6/6 or Thursday, 6/7). Invitations will be sent when cohort selection is final.

Workshop dates & agreement: signature *
By typing your name below, you commit to the statements above.
Your answer
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