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Instructional Coach Application and Letter of Commitment 2012-2013
Application Deadline: August 1, 2012
I, _____________________________________________ , wish to participate in the Reach
(First Name) (Last Name)
Professional Teacher Induction Program as a Participating Instructional Coach (please read
below).
Responsibilities as a Reach Instructional Coach:
Participating Teacher’s Formative Assessment:
o Develop a trusting and reflective professional partnership with Participating
Teacher(s).
o 3–5 hours with each participating teacher before school starts to assist with classroom
set up and planning.
o Assist Participating Teachers to develop an Individual Learning Plan based on The
California Standards for the Teaching Profession and their school site goals. Support
the teachers in making periodic adjustments based on feedback from formative
assessments and similar sources. Ensure participating teacher develops and completes
a professional development plan, based on the Individual Learning Plan.
o Ensure the participating teacher completes four inquiry action plans each year,
generating evidence of reflection on practice sufficient to demonstrate deep and
meaningful formative assessment.
o Provide weekly, on-site support to each Participating Teacher (averaging
approximately 1.5 hours each week, with the ability to vary group meetings,
observations, and one-on-one meetings tailored to the needs of the participating
teacher).
o Model/teach a lesson or lessons for each teacher you are supporting as appropriate.
o Co-plan, participate in and facilitate support and training activities for participating
teachers (including monthly collaborative group meetings if appropriate). May also
include: release-day workshops, veteran teacher observations, and an end-of-year
celebration/colloquium.
o Assist each teacher in developing and maintaining documentation of formative
assessment processes to be used as evidence of the teacher’s professional growth
activities.
o Assist each teacher in compiling and submitting the required portfolio.
Coach Professional Development including participation in:
o A coach orientation
o Reach facilitated instructional coach trainings
o Minimum year 1 training: Instructional Coaching consists of 4 x 3 hour
workshops with job embedded inquiry and online collaboration offered in
September/October.
PHONE FAX WEB
1221 Preservation Park Way, Suite 100, Oakland 94612 510.501.5075 510.868.2215 www.reachinst.org
o Minimum year 2 training: Coaching for Equity consists of 4 x 3 hour workshops
with job embedded inquiry and online collaboration offered in January-February
(may be completed in year 1)
o Coaching Forum: “Understanding Inquiry Action”
o Coaching Forum: “Deepening Coaching Practice”
o Coach Formative Assessment process based on a personalized Professional
Development Plan (PDP).
Review your Participating Teachers’ eligibility for BTSA; monitor and support non-
credentialed teachers on your caseload (if any) in their progress towards full credentialing;
refer PT to Reach Program credential analyst for specific information if necessary.
Submit meeting logs documenting contacts with your participating teacher(s).
Uphold the confidentiality agreement with the Participating Teacher.
Coordinate a meeting, once annually, with yourself, your participating teacher, and the
participating teachers site administrator to discuss learning goals and progress.
Coordinate with other teacher training/development programs within the Reach Program or
in your school, e.g., Intern Program, professional development program, etc. as necessary.
Participate in the program evaluation process (Mid-Year Survey) and comply with state and
program reporting procedures (BTSA Consent Form and Statewide Survey)
Non-Evaluation Statement
Coaches may not serve as a formal or informal evaluator for their participating teacher(s) and the
substance of formative assessment process must not end up by either formal or informal means
as part of the participating teachers summative evaluation (please see the Reach confidentiality
policy). By signing this letter, you are agreeing that you will play no role in the participating
teacher’s evaluation. Should the particular circumstances at your school make this difficult, it is
your responsibility to create an alternative evaluation process that abides by this requirement. If
you are unsure about how to meet this requirement, please contact the Reach Induction Program
Coordinator.
Technology Agreement
The Reach program includes online tools and a digital portfolio requirement. Coaches are
responsible for accessing sufficient technology to support participating teachers. In order to do
this, coaches will need to:
Maintain working access to a computer, sufficient to complete online formative assessment
documents: high speed internet access, reliable email access, and software applications
including MS Word and MS PowerPoint.
Maintain access to a scanner (either personal, school, or at library or retail location).
Support the Participating Teacher to maintain and submit digital evidence of Formative
Assessment Work.
Either use a laptop for note taking in one-on-one meetings (recommended) OR scan/digitize
formative assessment materials generated in meetings in a timely fashion following meetings.
Backup all Reach related files.
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Personal Information:
Coach/Applicant’s
full name: (first) (middle) (last)
Former Last Name?
Email
(REQUIRED):
What is your gender? Male Female
Social Security
Date of Birth? Number
*This information will be used by the CTC to confirm your credential status.
Employment Information:
Name of School Site
Name of School District
Are you employed by a Charter Yes
School? No
Coach/Applicant’s Primary Job assignment for 12-13:
Full Time Classroom Teacher: Content/Subject(s):
Itinerant/Roving Teacher: Content
Subjects:
Content Coach; Content area:
Teacher on Release, describe role:
Other; please specify:
Principal’s Contact Information:
Principal/Supervisor’s Name: Email:
1. What grade level(s) are you teaching this year? (Mark all that apply)
PreK K 1 2 3 4 5
6 7 8 9 10 11 12
Adults Not teaching this year
a) How many years, including the current year, have you been a
2. teacher?
b) How many years, including the current year, have you been a
BTSA Induction Coach?
Reach Induction Program – Instructional Coach Application 2012-2013 Page 3 of 5
c) Were you in the BTSA Induction Program as a Participating
Teacher?? Yes No
d) Are you employed as a full time release BTSA Induction
Coach? Yes No
e) Are you employed as a partial release BTSA Induction
Coach? Yes No
f) Are you a university faculty member? Yes No
g) Are you a retired teacher? Yes No
3. What is your ethnicity?
African American or Black
Asian American/Asian/Indian (e.g. Chinese, Japanese)
Latino/Latin American/Puerto Rican/Mexican American/Chicano or other
Hispanic
SE Asian American/SE Asian (e.g. Cambodian, Hmong)
Pacific Islander/Filipino
Caucasian (non-Hispanic)
Native American/Alaskan Native
Other: Formatted Table
Decline to State
Please Note: these are the categories required by the Department of Education. Mark all that
apply The Reach Institute for School Leadership affords equal opportunity to all students, and
other participants without regard to race, color, religion, citizenship, political activity or
affiliation, marital status, age, national origin, ancestry, physical or mental disability, medical
condition (as defined under California law), veteran status, family care status, sexual
orientation, sex (which includes gender and gender identity, pregnancy, childbirth, or related
medical conditions), taking or requesting statutorily protected leave, or any other basis
protected by law.
Where did you earn your teaching credential? (Please name the campus or district in
4. addition to the type of institution)
UC:
CSU:
Private Institution:
District Intern
Program:
Does not apply; received outside California:
State, if not CA:
Reach Induction Program – Instructional Coach Application 2012-2013 Page 4 of 5
US Territory:
Country, if not US:
Media Release
I give my permission to the Reach Institute for School Leadership (“Reach”) to use audio/video
recordings of my image, voice, and/or written materials submitted created through my participation in any
Reach program in any manner or form for any lawful purpose at any time.
The rights herein granted shall include the right to edit any of my statements or work for comments and
portions of the same in such a manner as Reach may determine. All portions of the production and
juxtapositions of audio/video recordings and other material shall be to the discretion of Reach.
Further, Reach shall have the right to distribute, exhibit or otherwise use this material in whole or in part
and in any medium, by means of television, videodisc, or otherwise.
I hereby release and discharge Reach from any and all liability arising out of any injury of any kind that
may be sustained by me from participating in or in connection with making or utilization of the material.
If, at the discretion of Reach, participants’ names are included in any credits, I want my name to appear in
the credits as shown below.
Consent & Affirmation:
I agree to participate in the Reach Induction program as an Induction Coach during the 2012-2013 school
year. I have read and understand the responsibilities, agreements, and expectations that becoming an
Instructional Coach requires from me. I understand that I am responsible for fulfilling all Coach
requirements, including attendance at Coach Forums and trainings and completion of paperwork required
by the program to document the growth and participation of Participating Teachers. Through the program,
I will participate in local program support, training, and assessment activities.
I certify that I possess a valid California Professional Clear Teaching Credential.
I agree to respond to official requests for information from the program leaders and administrative staff of
the Reach Induction Program and from representatives of the California Department of Education and the
California Commission on Teacher Credentialing who have responsibility for induction program reviews
and evaluations.
I understand that state and local officials will maintain the confidentiality of the information they receive
from me and that they will report only summary data about groups of teachers. My name and school
address may be released to institutions of higher education or research groups conducting approved
research on teachers and teaching. Further, none of this information will in any way affect the status of
my present credential, my future credential applications, or my employment status as a district employee.
I have read and understood the instructions and information given to me in this document. All information
I am submitting is true and correct.
Coach Name:
Coach’s Signature: Date:
After completing and signing the Reach Induction Application and Program Letter of
Commitment, please return a copy by fax or email (scanned with signature) to:
(510) 868-2215 Fax OR info@reachinst.org
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