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University and Reading Recovery Training Site Information
Year of Training for Applicant: 
Date of Application: 
University Training Center: 
Trainer Name:
Trainer Email:
Name of Reading Recovery Teacher Training Site: 
Teacher Leader First Name: 
Teacher Leader Last Name: 
Teacher Leader Email:  
-- Address of Teacher Training Site --

The applicant's i3 book bundle will be shipped to the teacher training site address.
Please, no P.O.addresses.
Building Name of teacher training site:       
City: State:     ZIP:  
Reading Recovery Teacher and School Information
i3 Reading Recovery Teacher: 
The applicant is replacing a Reading Recovery teacher in the building.
The applicant will be in a full-time position. (Please check box to verify.)   
School District Name:  
-- Address of School --
This building currently has Reading Recovery teachers
Building name:       
City: State:     ZIP:  
The applicant will teach Reading Recovery in a second school.

(DIRECTIONS: Choose from one of three prioritized categories below.)
Please check the following verifications box once you have selected all applicable criteria. The application will not be accepted unless this box is checked.
(Check as many that apply to the school building)
A school listed in Tier 1 on the state's School Improvement Grant List or
A Title I school in restructuring or corrective action or
A school is that is in a rural LEA. Rural LEA means an LEA that is eligible under the Small Rural School (SRSA) program or the Rural Low-income School (RLIS) program authorized under Title VI, Part B of the ESEA or
A school that has a sizable population of ESL students
If checking the criterion "sizeable population of ESL students," answer the following:
What is your state's proportion of ESL student?%   
What is the school building's proportion of ESL students?%   
A Title 1 school in Program Improvement (Year 1 or 2) or in a district in Program Improvement
Any other US school (publics/privates/parochials/charters)

Are there other sources of funding for the same grant purposes, as outlined in the MOA?