PEP Application — Alamance Achieves

Parent Engagement Program (PEP) Application

Alamance Achieves

Application Deadline: December 8th, 2023

Notification of Acceptance: December 11th, 2023

Confirm Attendance By: 5pm December 15th, 2023

Selection Criteria

Participation in the Parents for Public Schools (PPS) Parent Engagement Program is open to parents* (parents are defined as anyone who is a caregiver of children) who have or have had children in public schools or who work closely with parents and children. Participants will be selected on the basis of:

· Leadership potential

· Interest and/or active participation in schools and community

· Willingness to execute an individual leadership plan over several years

· Commitment to attend all sessions and to maintain an ongoing connection with the PPS network

Participants are selected without regard to race, color, religion, sex, disability, family status, or national origin. There is no charge for participation.

(Optional) Applicants submit one supporting reference (form linked below)

Please submit the completed application form by December 8th, 2023

For questions, contact Moriah Griffin at Moriah.Griffin@conehealth.com

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

Country

(###)

###

####

Do we have permission to text you with updates?

Please check one

Yes

Employer

Position

Children

Child #1: Age, Grade, Current School, School Next Year * If no children, School you are connected to

Children

Child #2: Age, Grade, Current School, School Next Year

Children

Child #3: Age, Grade, Current School, School Next Year

If you are accepted, at what school do you plan to work?

If you are accepted, would you attend daytime or evening events? Meetings will be held in-person at Impact Alamance (133 East Davis St., Burlington, NC 27215) (Please select one).

Option 1: Daytime Sessions: 9am-2pm; Kick off December 18th, January 16, February 20, March 19, April 16, May 21 June 18 - Option 2: Evening Sessions: 5pm-7pm; Kick off December 18th, January 24, February 14, February 28, March 14, March 28, April 11, April 25, May 9, May 23, June 13, June 27

If available, would you use childcare services during events?

How did you find out about the PPS Parent Engagement Program? (required)

List the ways in which you have been involved in your community or school. (required)

(Examples: PTA, Sunday School Teacher, Girl/Boy Scout Troop leader, committees, etc.)

What do you think we should do to improve student achievement? (required)

What are your major concerns about your school or school district? (required)

What does leadership mean to you? (required)

Optional

please answer these questions to assist us with reporting to our funders

Your Race/ Ethnicity

Age

Highest Level of Education Completed

Gender

(optional) Applicants can submit one supporting reference for their application to be complete. Please send the form linked below to one person who can tell the selection committee about you. Ask them to complete the form by the application deadline on December 4, 2023 (required)

I plan to submit one supporting reference

I am opting out of submitting a reference form

Parent Engagement Program (PEP) Application

PEP Reference Form