Form Application for Noyce MTL Program Nominees Email(Required) Name(Required) First Last School District(Required)AnsoniaBloomfieldBridgeportBristolDanburyDerbyEast HartfordEast HavenEast WindsorGrotonHamdenHartfordKillinglyManchesterMeridenMiddletownNaugatuckNew BritainNew HavenNew LondonNorwalkPutnamStamfordThompsonTorringtonVernonWaterburyWest HavenWinchesterWindhamWindsorWindsor LocksName of School(Required) Please confirm each of the following by Checking Yes or No.I hold a master’s degree in education or a related area.(Required) Yes No I have completed at least 5 years of public school teaching, with at least 2 years in an Alliance district.(Required) Yes No I am currently teaching in an Alliance School District.(Required) Yes No I hold a secondary math certification from the state of Connecticut.(Required) Yes No I am a U.S. citizen or permanent resident alien.(Required) Yes No Do you anticipate any circumstance which might prevent you from continuing with this project for its five-year duration (2022-2027)? Briefly explain.Your PerspectivesPlease answer each of the prompts (P1-P4) in 150 words or less. The Teacher Essay should be 350 - 500 words long. *Please note: For purposes of providing a fair review process, if over the given word limit, reviewers will be directed to read only the first 150 words, or 500 words, as specified in the directions.What does it mean to be a Teacher Leader?(Required)How do you ensure that all students (e.g., emerging bilinguals, students of different ethnicities/races), have opportunities to learn math in your classes?(Required)If someone made the following claim: “The children in Alliance District schools just can’t make academic gains,” how would you respond?(Required)What qualities and/or experiences do you have that suggest potential for serving as a math teacher leader?(Required)Teacher Essay. (350 - 500 words)(Required)Please describe your goals for participating in the program. What do you hope to learn, and what do you hope are the impacts? Please include some discussion of how your school and/or district will benefit Drop files here or Select files Max. file size: 100 MB, Max. files: 1. Evidence of Accomplishments(Required)Please upload your transcripts (undergraduate; unofficial copy is fine) Drop files here or Select files Max. file size: 100 MB. Evidence of Accomplishments(Required)Please upload your transcripts (graduate; unofficial copy is fine) Drop files here or Select files Max. file size: 100 MB. Résumé(Required)Please upload a current resume (no more than 2 pages) Drop files here or Select files Max. file size: 100 MB. Evidence of Commitment to Equity: Please describe up to 3 activities (provide a descriptive title, with brief explanation) that you have pursued to advance more equitable classroom-, school- ,or district-level engagement or outcomes.First briefly describe each activity (up to 3). For at least one activity, share documentation providing evidence of the impact of the activity. If you have more than three, please select those you think are most relevant for the Math Teacher Leader program. This evidence can take a variety forms, such as a presentation, student letter you received, student work with commentary, documentation of committee participation (e.g., agendas, committee report), student participation in a program over time, etc. Commitment to Equity Activity 1: Title and Brief Description(Required) Commitment to Equity Documentation / Evidence for Activity 1(Required) Drop files here or Select files Max. file size: 100 MB. Commitment to Equity Activity 2: Title and Brief Description Commitment to Equity Documentation / Evidence for Activity 2 Drop files here or Select files Max. file size: 100 MB. Commitment to Equity Activity 3: Title and Brief Description Commitment to Equity Documentation / Evidence for Activity 3 Drop files here or Select files Max. file size: 100 MB. Evidence of Leadership and Leadership Capacity. Please describe up to 3 activities or roles (provide a descriptive title, with brief explanation) that you have engaged at the department-, school-, or district level that demonstrated leadership or leadership capacity.First briefly describe each activity (up to 3). For at least one activity, share documentation providing evidence of the impact or effectiveness of the activity. If you have more than three, please select those you think are most relevant for the Math Teacher Leader program.This evidence can take a variety forms, such as serving as a mentor teacher or cooperating teacher; documentation of committee participation (e.g., agendas, committee report), conference presentations or leading district PD; organizing other initiatives, including programs, etc. Leadership and Leadership Capacity Activity 1: Title and Brief Description(Required) Leadership and Leadership Capacity Documentation / Evidence for Activity 1(Required) Drop files here or Select files Max. file size: 100 MB. Leadership and Leadership Capacity Activity 2: Title and Brief Description Leadership and Leadership Capacity Documentation / Evidence for Activity 2 Drop files here or Select files Max. file size: 100 MB. Leadership and Leadership Capacity Activity 3: Title and Brief Description Leadership and Leadership Capacity Documentation / Evidence for Activity 3 Drop files here or Select files Max. file size: 100 MB. Recommendation LettersPlease upload a letter from your principal and a letter from an Alliance District colleague (non-administrator) with whom you have worked closely. e. Upload Principal Letter of Recommendation(Required)The principal’s letter should be on school or district letterhead and detail: 1) Statement of leadership potential and ability to collaborate with colleagues and administration; statement of instructional quality (e.g., teacher evaluation observation rubric*, etc.); 2) impact on student learning (e.g., increase of standardized test scores, expanded learning opportunities for students, etc.); and 3) a statement of support for teacher engagement in all project activities over the 5-year program. *PLEAESE NOTE: This will not be used to compare teacher candidates, as each district is different, but principals could use this as supporting evidence. Drop files here or Select files Accepted file types: pdf, jpg, png, docx, Max. file size: 100 MB. e. Upload Colleague Letter of Recommendation(Required)Your colleague’s letter should be from someone who has worked with you closely, who knows your work and can speak to your character as a teacher dedicated to excellence and equity. The letter should detail: 1) How long you and your colleague have known each other, and in what capacity 2) Statement about you as a colleague 3) Statement about your dedication to excellence and equity, with supporting examples Drop files here or Select files Accepted file types: pdf, jpg, png, docx, Max. file size: 100 MB. Demographic Information**Gathered for National Science Foundation data-reporting purposesGender Female Male Non-Binary Prefer not to answer Ethnicity Hispanic/Latinx Non-Hispanic/Non-Latinx Prefer not to answer Race White Black or African American American Indian, Alaskan, or Hawaiian Native Asian Pacific Islander Two or more races Prefer not to answer Other No. of Completed Years of Teaching ExperienceNo. of Completed Years of Secondary Math Teaching ExperienceEmailThis field is for validation purposes and should be left unchanged.