On-Line Application

If you have an effective program in your district that you believe other educators could benefit from, we will review the information and provide you with feedback on the program's effectiveness, or, help you put an evaluation design in place to gather the information for you

Contact Information  (* = required field)

School District*:
Contact Person*:
Title*:
Address*:
City*: Zip:
Phone*: Fax:
E-Mail*:
 

Was this program/strategy developed locally*?

Yes No

I. Program/Strategy Description

1. Please choose the response that indicates how long the program/strategy has been in place.

2nd year 3-5 years 6 or more years

2. Determining Whether Your Program is Ready for Review.
Sharing Success is looking for programs which are formalized, consistent, and systematic. Program staff must have a clear understanding of the major purpose(s) of your program and its key components. WHAT does your program consist of and HOW is it implemented? To help you determine whether your program is ready to be reviewed by Sharing Success, please complete this checklist.

Questions1. Yes 2. No Comments
Program Design
a) Do you have clearly defined program goals/objectives that relate directly to the intended outcomes of the program?
b) Do you have a theoretical framework for your program which literature documents as a useful approach?
c) Have you specified the intended beneficiaries of the program?
WHAT: Program Curriculum/Process
d) Do you have a written curriculum/guidelines?
e) Do you have defined methods/process/instructional practices which include learner and teacher/trainer activities?
f) Is your curriculum aligned with the New York State Learning Standards?
g) Do you have learner and teacher/trainer materials developed?
h) Are there staff development activities to train staff in the program?
i) Can you specify key components of the program?
HOW: Program Implementation/Operation
j) Is there a location where the program is operating?
k) Does the program offer more than 35 hours of treatment for the intended beneficiaries? If not, estimate the hours and note it in the Comments column.
l) Are there defined roles for the implementers and participants?
m) Are there minimum requirements for participation in the program?
 

3. Program/Strategy Abstract (100-200 words). In the space provided below, please summarize the need for the program/strategy, the target population served, unique characteristics, etc.

 

II. Results

4. Please choose the box(es) that describe the program's/strategy's evaluation status. 
 (choose all that apply)
  No data exist to support the results of this program/strategy
  Some data exists:     Surveys   Achievement Data    Other
  Our data have been summarized but not analyzed for tests of significance
  Local evaluation report available

5. Please indicate the perceived areas of positive changes produced by your program/strategy 
     a. Changes were perceived for:  (mark all that apply)
  Students
  Teachers
  Parents
  School Organization/Operation

     b. The changes were in the following area(s):   (mark all that apply)
 Academic Achievement (e.g., increased knowledge; improved skills)
 Attitudes/Behavior (e.g., improved attendance; decreased drop out rate; improved attitudes
 towards learning, subject, school, self or job; decrease in substance abuse; decrease in discipline
 problems)
 School Operation/Management (e.g., improved cost effectiveness; expansion/efficiency of service
 delivery; increased participation rates; increased use of information services or resources)

     c. Other:

6. Please summarize the perceived changes due to your program/strategy in 2-3 sentences below. 

 

III. Replication

7. Please choose the types of costs involved in replicating your program/strategy elsewhere.

Staff: Training Additional Staff Needed  
Materials: One-time Purchase Consumable Materials Special Equipment
Other Agency Involvement: Volunteers Partnerships Fees

8. I will e-mail or send hard copies of the following materials that describe our program in greater detail.
Goals and Objectives Newsletters
Course Description Newspaper Article(s)
Curriculum Guide/Syllabus Memo(s)
Teacher's Guide Other
Brochure/Flyer No written materials are available at this time

9. I will e-mail or send hard copies of the following evaluation materials checked below.

Locally Developed Instruments (e.g., sample copy of tests, surveys, rubrics, portfolio,
      record keeping form, or names of standardized instruments used)
Summary of Evaluation Data collected (e.g., tables, figures, etc.)
Evaluation Report/Summary
Summary of Sampling Procedures/Methodology
Evaluation Plan/Design
No materials to forward but we are willing to gather data with assistance


For items #8 and #9, please e-mail files to: keefe@sharingsuccess.org
or, if you are sending hard copies of the materials, please mail them to:

Elizabeth Keefe, Research Assistant
Sharing Success Technical Assistance Center
The Westchester Institute for Human Services Research, Inc.
7-11 South Broadway, Suite 402, White Plains, NY 10601
phone: (914) 682-1861 ext. 312     fax: (914) 682-1760

 

After clicking the Submit Survey Button, you should see a confirmation page saying that "Your Survey was Submitted". 
If you are having problems with this survey, please send an e-mail to the following address: Problems@Westchesterinst.org