WKEC Professional Learning Request

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Email *

District *

School Name (if applicable)

Name of School Principal (if request is for school level assistance)

Teacher (if applicable for request)

Area of Focus

(check all that apply)

Alternate Assessment

Assistive Technology

Behavior/Mental Health

Communication

Compliance/Due Process

Co-Teaching

Disability Specific

IEP/Progress Monitoring/Specially Designed Instruction

Literacy

Low Incidence

Mathematics

PBIS/ISF

Post Secondary Transition

Professional Learning in District (indicate topic in explanation for request below)

Sensory Processing

Other (describe in explanation for request below)

Other:

Required

Please explain the reason for this request.
*

Number of students with IEPs who will be impacted by services provided.
*

WKEC Professional Learning Coach(es) Requested for this PLR (check all that apply)
*

Martha Daniel (Literacy)

David Daniel (AT, UDL, Sensory Issues, Trauma Informed Care)

Candice Frick (Behavior, Co-Teaching, IEP/Progress Monitoring, PBIS/ISF)

Pamela Ward (School Pyschologist)

Rachel Johnson (DoSE Support, Data Analysis, Due Process, Instruction)

Kayla Jones (PBIS/ISF, SEL, Mental Health)

Carla Mangels (Co-Teaching, Due Process, IEP/Progress Monitoring, Trauma Informed Care)

Laura Miller (Communication, AT, Low Incidence, Peer Support Network)

Kevin Stephens (Co-Teaching, Low Incidence, ASD)

Not sure. Please assign.

Other:

Required

The Professional Learning Coach being requested has already had conversation with district staff about this request and is aware that it is being submitted.
*

Yes

Requested format for service delivery
*

After school professional learning session for teachers

Classroom coaching with an individual teacher or multiple teachers

Classroom observations to determine teacher needs

Coaching staff through an AT evaluation

Data collection of instructional practices in identified classrooms

Professional learning session on a scheduled district/school day

Working with staff on setting up a sensory room

Other (describe in section below)

If other was selected, explain in this section.

Is this request a result of a Corrective Action Plan? *

Yes

Who will serve as the internal coach for this request ? (The coach should be someone whose role is specifically related to the area(s) of request. Internal coaches may include (but are not limited to): teacher leader, consultant, instructional supervisor, department chair, administrator, speech language pathologist, guidance counselor.) Please list name of individual, email information and contact phone number.
*

Please check the following (all must be checked before submission of the request).
*

We have identified the internal coach who will support the WKEC Professional Learning Coach during scheduled visits and provide support to teachers in between visits.

We understand that the internal coach’s role is to ensure capacity continues to grow at the classroom, building, or district level.

We agree that the identified internal coach will be provided release time as needed to fulfill this role.

The Director of Special Education is aware that this professional learning request is being submitted.

Required

Name and title of person submitting request
*

Email address of person submitting request
*

Comment Section (please provide any information that will assist with the request in this section)

A copy of your responses will be emailed to the address you provided.

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