Application+Form

Please complete as fully as possible. Information may be added later. email to: sbranton@kente.edu and Sara Reith" <wstr_sreith@woostercityschools.org
 * MI-Inspired RtI Reading Project Application **


 * Name / Title of Applicant --- District / Organization / School **

Address

Daytime Phone # of Applicant -- email

Teachers Involved

Contact Person(s)

School Psychologist:

Principal:

Time Line: Begin............................ End..................................

__**Pilot Project Kit**__

__**The MIDAS Handbook: MI in the Classroom**__

__ **Choose:** _ Online MIDAS System (OMS) or Paper and Pencil Questionnaire (reproducible). __

__ **How many Profiles** _ **Age**:__ MIDAS: adults / college students __Teen-MIDAS (15 – 19 years)__ All About Me (10 – 14 years) __MYC: MY View ( 9 years, 3rd grade)__ My Young Child (4 – 8 years)

Student MI information and MIDAS Interpretative materials:


 * Grade Levels**

Reading Pre-test: Reading Post-test:

MI Reading Instruction Group Activities (Ling, Inter, Intra, Logical, etc.)

other:


 * - Special Requests:**

//Please provide a brief summary of your proposed project//

__ //.// __  **Pilot Project Plans and Objectives**
 * MIDAS Administrator:**


 * Goals / Objectives:**

Staff Training: MIDAS training

MIDAS Administration:

Reading Pre-test:date_

Intervention Frequency:

Activities Included:

Formative assessment / monitoring:

Student Exit Surveys _ Teacher Observations _ Parent materials_

Reading Post-test:

Other: