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Lake Superior Carl Perkins Consortium Standard Request Form for Secondary Schools 2021-22
Please contact Secondary Perkins Coordinator Leah Bott with any questions regarding your request.
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* Indicates required question
Email
*
Your email
Name
*
Your answer
School(s) - Check all that apply.
*
Barnum
Carlton
Cloquet
Cook County
Cromwell-Wright
Duluth AEL/AEO
Duluth Denfeld
Duluth East
Esko
Fond du Lac
Hermantown
McGregor
Moose Lake
Proctor
Silver Bay
Two Harbors
Wrenshall
Other:
Required
State teacher license(s) # (six-digit file folder #)
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Your answer
CTE Approved Program Code(s)
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Your answer
Course Name(s) and Course Code(s) that will benefit from this request
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Your answer
Is this course(s) part of a State-approved POS?
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Yes
No
Room # where this class(es) are typically held
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Your answer
Funds requested for: (check all that apply)
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TSA’s (costs for Technical Skill Assessment pretest and posttest of students)
Student Clubs (Non-consumable supplies, costs of advisor lodging & meals)
Professional Development (conference fees, accommodations, mileage, subs)
Student Field Trips (mileage and transportation costs, subs)
Industry Connections (mileage and sub costs, industry shadowing, AMFA meetings
Program of Study (POS) (broaden the impact of CTE programs and meet Performance Indicators)
Other (Please explain in detail below.)
Required
Total amount of this request
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Your answer
Proposed Budget: Description of individual items and cost of each.
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Your answer
Expenditure that is being requested
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Your answer
Briefly describe how this expenditure supports career and technical education within your CTE courses.
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Your answer
Has the expenditure been previously funded with local funds?
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Yes
No
Number of students in grades 7-12 that will benefit, participate, or be involved.
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Your answer
Will any other high schools, groups, or colleges be involved?
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Yes
No
If yes above, please list them.
Your answer
Do students receive post-secondary credit for this course(s)?
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Yes
No
If yes, which post-secondary institution?
Your answer
Are other funding sources being used to complete this project/request?
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Yes
No
If yes above, please list the source.
Your answer
I verify that I am recognized as a certified CTE instructor by the state of Minnesota and that the above-mentioned request for funds will be used only in conjunction with a course or courses that have been approved as a secondary CTE program by the Minnesota Department of Education.
*
Yes
No
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