FY21 Instructional Model Approval Form
1. Review requirements for each model ensuring that all requirements can be met.
2. Gather feedback from families and staff.
3. Determine model to be used for each classroom. When model(s) is selected, the program is committing to using the model(s) for a minimum of the first nine weeks. Changing a selected model requires prior approval.
4. Submit this model approval form for EACH site to DECAL by Wednesday, July 22nd or contact your Pre-K specialist if you need an extension.
5. Forms will be reviewed, and feedback provided within 48 hours.
6. Once you have submitted the form, you will be given the option to begin another form if you have more than one site.  
7. Please reach out to your Pre-K Specialist if help is needed.
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Email *
Legal Name *
Site Name *
County *
Zip Code *
Specialist's Name *
How many TOTAL Pre-K classrooms are at your site? *
DIRECTIONS: Select the model to be used for each classroom. If a model is not being used, type N/A for your response.  Some questions will require you to select a number for your response instead of typing N/A.
TRADITIONAL MODEL
How many total classrooms for this site will be using the TRADITIONAL MODEL? *
Briefly explain the rationale for selecting the TRADITIONAL MODEL? Please type N/A if not using this model. *
How many children are registered at this time for the TRADITIONAL MODEL? Please type the number 0 if not using this model. *
HYBRID MODEL
How many total classrooms for this site will be using the HYBRID MODEL? *
How many children are registered at this time for the HYBRID MODEL? Please type the number 0 if not using this model. *
Will teachers that are engaged in the HYBRID Model, be required to report on site daily? *
 If using the HYBRID Model, please answer the specific questions below.
HYBRID MODEL QUESTION 1: Indicate how you plan to implement the hybrid model. *Refer to the guidance document for definitions. *
HYBRID MODEL - If you selected OTHER above,  describe your hybrid model. Please put N/A for your answer if you will not use this model. *
HYBRID MODEL QUESTION 2: Briefly explain the rationale for selecting this model (split schedule, entire class, two-day rotation, or other). Please include the days that are face-to-face and distance learning. Please put N/A for your answer if you will not use the Hybrid Model. *
HYBRID MODEL QUESTION 3: What are the start and end times of the physical school day? Please put N/A for your answer if you will not use the Hybrid Model. *
FULL DISTANCE MODEL
How many total classrooms for this site will be using the FULL DISTANCE LEARNING MODEL? *
Briefly explain the rationale for selecting FULL DISTANCE MODEL? Please put N/A for your answer if not using this model. *
Will teachers that are engaged in the FULL DISTANCE Model, be required to report on site daily?  Select N/A for your answer if not using this model. *
How many children are registered at this time for the FULL DISTANCE MODEL? Please type the number 0 if not using this model. *
All information provided in this survey is true and accurate. I understand that falsifying information reported could result in automatic termination of the grant agreement. *
Required
According to DECAL's guidelines, I agree to fulfill the requirements of the model(s) that have been chosen for the upcoming school year. *
Required
If full distance learning is chosen, I understand that all teachers and families involved must have access to high speed internet and a device (computer, tablet,smartphone) for virtual instruction. Learning materials and supplies will be provided by the Pre-K Program and rotated on a regular basis. *
Required
By my typed signature below, I acknowledge and confirm that the information that I have provided is true and correct and I agree to abide by the terms outlined by DECAL.   *
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