MOUSE Squad Application

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 and Title:

   Email:

    
4. Who is the school/agency administrator who will be working with MOUSE Squad?
   

   Name and Title:

   Email:

    
5. Who should receive the invoice for the MOUSE Squad program?
   

   Name and Title:

   Email:

    
6. Who is the site or district contact person for volunteer policies?
   

   Name and Title:

   Email:

    
7. From which schools and/or districts do your students come? 
   
    
8. To which schools and/or districts do your students graduate?  
   
    
9. What community or business partnerships do you have for potential volunteers?  
   
    
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?
    Select start date: Summer 2010 2010-2011 School Year Don't Know Yet
     
    If you selected the upcoming school year, please answer the following questions:
    
    

    12a.	Is the MOUSE Squad team (Instructor, Tech Coordinator, and Administrator) available to attend an all day training session (see 12c below)? Yes     No
    12b.	Who are the MOUSE Squad instructional team members, their positions, and e-mail addresses?
    12c.	Please select your 1st and 2nd choices for attending the MOUSE Squad training: Select 1st Choice: June 2010 August 2010 September 2010 Select 2nd Choice: June 2010 August 2010 September 2010

     
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 - $2,000 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 $1,500 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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