PI-1574-A Individual Precollege Program Data

Wisconsin Department of Public Instruction INSTRUCTIONS: Complete a separate sheet for each INDIVIDUAL PRECOLLEGE PROGRAM INFORMATION Precollege Program and attach with the Proposal Application. PI-1574-A (Rev. 02-17)

For questions, contact: Mary Lou Hyatt at (608) 267-9161 or [email protected]

NOTE: This form must be completed for each precollege program offered by the institution. The Precollege Scholarship Program is a two-year cycle. If the institution will be offering an identical precollege program both years, indicate all sessions that will be offered. Applications with multiple different programs will not be considered unless this form is completed for each program offered and is included with DPI Precollege Scholarship Program Proposal Application (Form PI-1574).

I. GENERAL INFORMATION

Name of Precollege Program Name of Institution College / University

Contact Person First and Last Name Title

E-Mail Address Phone Area/No. Fax Area/No.

Session Year One Summer (July 1, 2017 – August 31, 2017) Fall (September 1, 2017 – December 31, 2017) Spring (January 1, 2018 – June 30, 2018) 2017-18 Academic Year (fall and spring with program beginning first semester and continuing through the second semester)

Year Two Summer (July 1, 2018 – August 31, 2018) Fall (September 1, 2018 – December 31, 2018) Spring (January 1, 2019 – June 30, 2019) 2018-19 Academic Year (Fall and Spring with program beginning first semester and continuing through the second semester) Type of Program

Residential Non-Residential

II. DESCRIPTION OF PROGRAM

Provide a description of the program including purpose of the program, grade level(s) to be served, target number of Total No. of Contact Hours* students to be served, and the number of days and total contact hours participants will receive.* Attempts should be made to limit response to the space provided. Attach additional pages only if necessary.

*If the number of contact hours for the precollege program is not included, the program will not be considered for funding. Page 2 PI-1574-A

III. GOALS / OBJECTIVES

Goals: Identify the goals for this precollege program. When developing goals, keep in mind the overall purpose of the project. Consider the following when developing goals: 1) Goals should be measurable, 2) Goals should be clearly and succinctly written. Objectives: Objectives provide the framework by which a given goal is met. Clearly written objectives also provide the basis for evaluation methods. Program objectives must address at least one of the following: 1. Preparing students to become college and career ready. 2. Reinforcement in basic skills and competencies such as reading, writing, speaking, listening, mathematics, and reasoning. 3. Reinforcement in skills and attitudes necessary for success in college and employment, including study skills, work habits, and instructor and employer expectations. 4. Special experiences, such as computer camps and workshops in science, mathematics, writing, reading, arts, and the humanities 5. Reinforcement in employability skills and attitudes. Precollege Programs may also include other components, such as the following: 1. Information on financial aids available to all pupils. 2. Career guidance and counseling. 3. Information on college living such as dormitory life and support groups. 4. Information on college application procedures. When developing goals and objectives, make sure that they are S.M.A.R.T. goals and objectives. Specific Measurable Attainable Realistic Time-limited

PI-1574-A Page 3

IV. EVALUATION PLAN

Describe in detail the evaluation procedures and methods that will be used to determine whether the program’s goals and objectives are being met. The evaluation method must be consistent with the measurable outcomes that were described when discussing the goals and objectives on page 2. Attach additional pages only if necessary.

V. SCHOLARSHIP INFORMATION

Cost per Pupil (Scholarship Amount Per Pupil Requesting) * Target Number of Students to be Served TOTAL Amount of Request Round to nearest dollar $0 *Scholarship amounts must be consistent with this table. If the number of contact hours for the precollege program is not included, the program will not be considered for funding. Residential Programs Non-Residential Programs Contact Hours Maximum Scholarship Amount Contact Hours Maximum Scholarship Amount < 100 $1,300 < 50 $600

100 – 200 $1,600 50 – 100 $750

> 200 $1,900 > 100 $900