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Please print or type the following information:

School District Name________________________________________________________________

Contact Person_____________________________________________________________________

Address___________________________________________________________________________

Please List your District Team Leaders (limited to 3 individuals)

(May bring a second principal for an additional $150.00)

Do you have a technology plan?________________ If so, what is the last revision date?_____________

Has it been approved by the school board?_______If so, date approved by the school board?_________

Do you have a district school improvement plan?___If so, what is the last revision date?_____________

Has it been approved by the school board?________If so, date approved by the school board?________

Please describe the extent to which your curriculum and technology are integrated in your school district.

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How would you rate your district in its technology planning and implementation? (Circle One)

1. We haven’t really started yet.
2. We are just getting started with our planning.
3. We have the plan written but need to start implementation.
4. We have started implementation of the technology plan.
5. We have are making good progress with implementation but need to more closely align our curriculum and technology planning.
6. We have fully integrated our curriculum and technology.

A check payable to Michigan State University in the amount of $150.00 for a team of three (additional $150.00 for a second principal) is due upon acceptance.

See Page 2