Attention POST for Teachers Be A

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Attention: ________________________Please POST for Teachers Be An Early Bird and Save 20% on IMPACT This Year!
(fax 713-556-7189, ph 713-556-7182)

2008-2009 Membership Form
Name ________________________ School ____________________ Payment Options: Memberships paid from Aug 15-Nov 3 are $100. After Nov 3rd - $125.
Make checks payable to HISD IMPACT II. Or, Houston ISD schools may use the mote/transfer below. SR1 or GF1 may be used. If you don’t have 13-6291 call your Budget Analyst to add the commitment item for you. Activity fund or personal checks may be used.

Total Amount for School Membership Services and Supplies: _________Business Area_____ Fund ____ Fund Center _________ Commitment Item 13-6291 DR/CR 40 Signature of Budget Authority _____________________

2008 – 2009 IMPACT Grant Application
PLEASE PRINT: Name __________________________ EM ID ________ School _________________________ Phone: School _____________ Cell ______________Describe what you do at your school. ________________ Grant Deadline Sept 30 I agree to two events or attend make-up work sessions if I miss them. I am applying for the following grant (2 max.) __ Initial January Awards Dinner where we honor all Grant Winners __ Initial Next year (Sept. 09) come to Teacher Secrets Event to tell about the type of IMPACT grant I participated in. __ Initial I understand that my school must be an IMPACT Member School in order to apply for IMPACT Grants.

1. Big Stuff SupplyGrant 2 hr Work Sessions at IMPACT to help us with IMPACT projects. You choose
from items below for your hrs. Which day(s)? __M __T __W Which month? __ Sept __ Oct __ Nov Which starting time? __3:30 __4:30 __5:00

(List specific dates you tentatively plan to come for your 1st work sessions ___ ___ ____) Work sessions are 2 hrs. The 1-2 item(s) I want to earn is: __ Digital Camera w memory crad (12 hours/6 sessions) __ Flat Panel Monitor (12 hrs) __Desktop Laminator/pouches(12 hrs) __Small Binding Machine(6 hrs) __Small Die Cut Machine w 5 dies (12 hrs) __All-In-One Printer (6 hrs) __ Flash drive (2 hrs) __Bks from Richardson’s Bks (2hr = 8 bks) __Projection Connector that projects from computer to TV (10 hrs), __Small Boom Box\CD Player(2 hrs) __Portable DVD player(12 hrs) __MP3 Player(6 hrs), __Spanish Translator/Diction (8 hrs)
(#) Number indicates number of hours to come to IMPACT Office that item requires. ___I am willing to come to the IMPACT Office to do General Office Work and help on IMPACT projects.

2. Stipend Grants
__ Workshop Presenter for an IMPACT workshop for my school. This pays $100 stipend and requires that your school requests 1 of the IMPACT early dismissal trainings and designates you as the trainer. See IMPACT web. Session titles are on the IMPACT web. __ Artwork Grant (4 pgs of artwork $120, our choice) Hand-draw artwork for IMPACT projects and publications __ Author’s Grant $120 for 5 Monologues written as specified on IMPACT web. __ TAKS Game Grant $120 must come 8 times. Make 2 complete games, designed/correlated to TAKS. Make game sample of each.

3. IDEA/Developer & Adaptor Supply Grants –
HISD Vendor PO
What is the My Great Idea Developer Grant? $250 Got original ideas that work? This grant is for
you! This grant is for teachers who can’t help but come up w original, great ideas and love to share them. REQUIRED ATTACHMENT 1. Attach to application, a typed narrative (1-PAGE MAX w this format.
 Write in third person using past tense and complete sentences.  List Program Title, Subject/Curriculum Area & Grade at the top.  List the TAKS Student Expectation and Objective or Stanford Objective your program addresses under the Program Title.  Use these 4 headings to denote the sections: PROGRAM DESCRIPTION THE STUDENTS MATERIALS AND FACILITIES OVERALL VALUE

What is an Adaptor Grant?

$110 or 6 hrs of Big Stuff Items. This is a Vendor grant to assist a teacher to replicate an IDEA PERSON's (Developer) program listed on HISD IMPACT web. Name of the IDEA PERSON's (Developer) _____________________________________________ Program you want to adapt _____________________________________________ Name of IDEA PERSON (Developer) Teacher: (See Web) _____________________________________________ What subject(s) do you teach? ______________________
Total # of students to be involved in the replication: ___ Attach 2 sentences on these 4 questions. Max 1/2 pg typed 1. What is the educational need for this program in your class? 2. How will this program benefit your students? 3. What qualities of this program most impressed you and why 4. Describe any modifications you expect to make in this program I will write a personal note to 5 other teachers to encourage them to participate in the IMPACT network. __Y __N Materials - I understand the purpose of the grant is to buy materials to replicate the program. __YES __NO Project/describe the types of materials you would need to replicate this program. ____________________________ _______________________________________________ Cost (Estimate) ______

1) How long has your program/ strategy/idea been in operation? ___ The program must be currently or recently successfully implemented by you. It must be innovative and you developed yourself with broad enough appeal for other teachers to adapt to use in their classroom(s). 2) Adaptor Grants are $110 this year, so estimate what it would cost for an Adaptor to replicate and use your idea? $ ____ 3) I verify this idea is my original idea, not copied. __Y __N 4) I will write to at least 5 teacher thru school mail to invite them to be part of IMPACT __Y __N 5) If selected you will create a 3-10 pg packet for Adaptors, e-mail a digital photo or bring a 35 mm photo to us, and your requisition items. __Y__N

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