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MOUSE Squad Application

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STEP 1

If you represent a school or district that is interested in implementing a MOUSE Squad, please answer all of the questions in the Application Form below to the best of your ability. Responses to all questions are required.

STEP 2

In addition, please complete the Site Status Assessment Survey.

NOTE: This application is not complete until both the Application form and the Site Status Assessment Survey are completed.
 

Application Form


Your Name:
Today's Date (mm/dd/yy):
Site or School Name:
Site or School Address:
(Address, City, State & Zip)
School District:
Site or School County:
Contact Email:
Contact Phone:
  1. How would MOUSE Squad Student Tech be a useful program for your school or agency?

     
  2. In what activities are students already engaged related to student technical support?

     
  3. Who will be the MOUSE Squad instructor/faculty advisor for the program?
    Name: Email:
     
  4. Who is the school/agency administrator who will be working with MOUSE Squad?
    Name: Email:
     
  5. Who is the site or district contact person for volunteer policies?
    Name: Email:
     
  6. From which schools and/or districts do your students come? 

     
  7. To which schools and/or districts do your students graduate?  

     
  8. What community or business partnerships do you have for potential volunteers?  

     
  9. Do you have videoconferencing facilities on site or available at a nearby County Office of Education or business that could be used for volunteer orientations?
    Yes     No
     
  10. What is your site's percentage of Free/Reduced Meals?
     
  11. What tools do you have in place to measure the impact of MOUSE Squad on student achievement, and the benefits to students, teachers and the school as a whole?

     
  12. When do you want to begin implementing MOUSE Squad Student Tech?

     
    If you selected "School Year 2008-09", please answer the following questions:

    12a.

    		 Is the MOUSE Squad team (Instructor, Tech Coordinator, and Administrator) available to attend an all day training training session in Silicon Valley (see 12c below)?
    Yes     No
     
    12b. Who are the MOUSE Squad team members, their positions, and e-mail addresses? 

     
    12c. Please select your 1st and 2nd choices for attending the MOUSE Squad training (training will be held at the San Mateo County Office of Education, Redwood Shores, or KCI Foothill College in Los Altos Hills):
     
  13. Would you like to apply for a MOUSE Squad Mini-Grant (see Funding page for more information)?
    Yes     No
     
  14. How are you funding MOUSE Squad for Year 1 ($2,500 or less if you are applying for a mini-grant)? (Note: After School Prop. 49, site or district program allocation, local businesses, foundations, and service organizations are a few of the sources that schools are using for MOUSE Squad Student Tech funding.)
     
  15. How are you funding the $2,000 renewal fee for each of years 2 and 3 to sustain the program?

     
  16. How did you hear about the MOUSE Squad Student Tech program (if from another website, please identify it)?

     
  17. Any additional comments?
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Please remember to also complete the Site Status Assessment Survey.

NOTE: This application is not complete until both the Application form and the Site Status Assessment Survey are completed.

Fee is $2,500 for the first year for licensing, training and program management and $2,000 annually for subsequent renewal fees. MOUSE Squad of California subsidizes the remainder of the program cost. Grants are available.