All Fields are required.

Name of Program:
Director/Principal Investigator:
Address 1:
Address 2:
Phone:
FAX:
Web Address:

PART II: PROGRAM OVERVIEW

a. GENERAL PROGRAM DESCRIPTION

1. Please describe your program in 100 words or less.

2. When was the program established?

3. What is the program’s mission or overarching goal?

4. What are the program’s strengths?

5. What areas does the program still need to address/improve?

6. Does the program have the support of partners in the community?

6a. If yes, who are the partners and what type of support do they provide?

7. What is the reach of the program (i.e., how many schools, students,teachers participate, etc.)?

8. Please describe the target population for the program (e.g., middle school African-American and Hispanic-American students; Native American elementary school students)?

9. If available, please provide a copy of the most recent annual report/background material about the program.

b. PROGRAM COMPONENTS

1. Please describe the program’s major components (i.e., teacher training, curriculum, material resource center, kit refurbishment, etc.).

2. What curriculum/materials are used? Please describe them.

3. Does the curriculum/material

*relate to real-world applications? YesNo *foster critical thinking, problem solving and team working among students? YesNo *encourage students to reach beyond minimum competencies? YesNo *reflect local, state and/or national science standards? YesNo

4. Explain the role teacher professional development plays in the program, how it is conducted and how often?

5. Describe the classroom or learning environment that the program creates for facilitating science learning.

6. Does the program create an environment where

*teachers and their students work together as active learners YesNo *teachers have access to and time allotted for professional development that hones their science knowledge and experiential teaching approach YesNo *necessary curriculum materials are supplied in full YesNo *students’ diversity, individuality and uniqueness are recognized and respected YesNo

c. PROGRAM ASSESSMENT

1. Please describe the program’s assessment tools.

2. Please summarize the program’s latest assessment results. Be sure to clearly indicate how the program is successfully reaching under represented students (i.e. girls, African Americans, Hispanics and/or American Indians).

3. How does the program utilize the assessment data, both positive and negative?

4. If available, please provide a full copy of the program's latest assessment results report.

Part III: VALIDATION AND AUTHORIZATION

By signing this information validation and authorization of use form on behalf of the program, you:

1. Acknowledge that all of the data, answers and information provided about the program in this submission form are true and factual.

2. Grant Bayer Corporation permission to publish the information contained within the submission form and all other submitted documents within the body of the Best Practice in K-12 Science Education Compendium and disseminate it broadly using any and all possible communications tools.

Program Director Name: