TEACHING OF AMERICAN HISTORY GRANT PROGRAM APPROVAL FORM

Northwest Suburban American History Consortium 343 East Briarwood Lane Palatine, Il 60067 David Freeman- Project Director Dr. James Breunlin- Evaluation Dr. Robert Johnson- Academic Coordinator Contact NSAHC at nsahc.org -or- 1- 847- 303- 6628

Part I- General Information of Applicant

Name: ____________________________________________________________________________________________________ School: ___________________________________________________________________________________________________ Department: ______________________________________________________________________________ Year Hired _____________ Highest Degree Earned: _____________________________________________ Are you currently teaching an American History class- yes________ no_________ Undergraduate Major: _______________________________________________________________________ Proposed Degree: ___________________________________________________________________________ If this class is being applied for Graduate Credit – to which institution?________________________

Part II- Individual District Policy and Procedures to be Completed by Applicant

Teachers in District #211 must complete the following forms: v Graduate Study Program Approval Form v Form #211-1 Application for Pre-Approval of Graduate Work Procedure for Tuition Reimbursement

Teachers in District #214 must follow the following steps: Case 1: For those who do not have a Masters degree, they should complete Attachment I [Vertical Step Advancement]. Upon completion of the coursework, one must submit Attachment J [Completion of Professional Growth Credit]. Case 2: For those with a Masters, but no plan, one must submit either an Attachment E [Masters +30] or Attachment F [Masters +60]. Case 3: Those with a current plan may submit an Attachment G [Addendum to plan].

Note that these steps must be completed prior to start of the graduate level course and any summer symposium program offered by the Northwest Suburban American History Consortium. The project director will confirm with the individual school district that these outlined procedures have been filed when a class list is submitted to Jeffrey Butzen of District #211/ Judith Minor of District #214.

Part III- Class Registration InformationInformation:

Course Title: ______________________________________________________________________________ Class or Symposium Date ____________________________________________________________________ _____________________________________________________________________________
Instructor or Symposium Sponsor: __________________________________________________________________________________________________________________________________________


I UNDERSTAND THAT IN ADDITION TO THIS FORM WHICH IS INTENDED TO SERVE AS APPROVAL FOR A SPECIFIC COURSE OF STUDY OFFERED BY THE TEACHING OF AMERICAN HISTORY GRANT FUNDING, I MUST ALSO COMPLETE THE FORMS REQUIRED BY MY DISTRICT PRIOR TO THE START OF EACH COURSE OF STUDY IN WHICH I ENROLLENROLL.

Applicant’s Signature: ____________________________________________ Date ___________________

Approved by Department Chair: ____________________________________ Date___________________

Approved by Principal: ____________________________________________ Date___________________