ZERO ROBOTICS APPLICATION 2017 MIDDLE SCHOOL SUMMER PROGRAM Application Instructions Toapply,pleasecompletethefollowingapplication.Narrativeresponsesshouldbenomorethantwotypedpages.Applicationsmaybesubmittedviae-mailtoEricShawateshaw@massafterschool.org.Applicationssubmittedbye-mailwillreceiveaconfirmationnote. Forquestionsoradditionalinformation,pleasecontactEricShaw.

COMPLETEDAPPLICATIONSMUSTBERECEIVEDBYWednesday,April19,2017.Applicationsandanyattachmentmustbesubmittedviae-mailtoeshaw@massafterschool.org

with“ZeroRoboticsApplication”inthesubjectline. Eligibility Anypublicorprivateschoolorcommunity-basedorganizationthatservesmiddleschoolyouthiseligibletoapply.Programsmustserveateamof10-20youthforaminimumof15hoursperweekfor5weeks. Priorityconsiderationwillbegiventoprogramsthatserveunder-representedorunder-servedpopulations.Eachprogrammusthavecomputersandinternetaccess. MassachusettsAfterschoolPartnership 128ATremontSt.Suite4f Boston,MA02108

6173380057 EricShaw

PART I: Organizational Information Organization Information and Community Demographics ORGANIZATIONNAME

ADDRESS CITY ZIP

PHONE FAX WEBSITE

Social Media TWITTER

FACEBOOK

INSTAGRAM

OTHER

Pleaseplacean‘X’alongsideallthatapply:

School/Schooldistrict

21stCenturyCommunityLearningCenter

Community-BasedOrganization

Faith-BasedOrganization

Other(pleasedescribe) Contact Information EXECUTIVEDIRECTORAND/ORPRINCIPAL PHONE EMAIL

PROJECTCOORDINATOR(ifdifferent) PHONE EMAIL

ZeroRoboticsApplication:MiddleSchool2017SummerProgram Page2

Community Information: Pleaseindicatethepercentageofstudentsinyourcurrentprogramorschool.

· Gender:Female:______%Male:______% · Low-Income(receivingfreeorreducedlunchand/orcontracts/vouchers/subsidies):______% · Childrenoryouthwithdiagnoseddisabilities:______% · EnglishLanguageLearners:______% · Racial/EthnicDemographics

PERCENTAGE Race/Ethnicity

% AmericanIndianorAlaskaNative

% Asian

% BlackorAfricanAmerican

% HispanicorLatino

% NativeHawaiianorPacificIslander

% WhiteorCaucasian

% Other

· Pleaseidentifyfromtheabovedemographicsthestudentsthatyouwillspecificallytargetfor2017

participationinZeroRoboticsandhowyouwilloutreachtothem: ZeroRoboticsApplication:MiddleSchool2017SummerProgram Page3

PART II: Narrative Pleaserespondtothefollowingquestionsbrieflyandconcisely(nomorethan2typedpages). Provide a Brief Description of Your Program and Partners

· Doesyourorganization/schoolcurrentlyofferaSTEMcourseand/orcurriculumduringthesummer?

· Ifyes,pleasedescribeyourSTEMofferings,anyonlineorprintedSTEMcurriculayouhaveused(i.e.NASAK-12onlinecurriculum,FIRST,EiE/EA),andexplainhowtheZeroRoboticsProjectwillcomplementyoursummerlearningprogram.

· Ifno,pleaseexplainhowandwhyyouwouldliketoaddaSTEMcomponenttoyoursummerprogram

throughZeroRobotics.

· DescribeanyparticularexperiencewithcomputerprogrammingorteachingSTEMsummercurriculathatyourstaffmembersorvolunteersmayhave.

· StrongpartnershipsareessentialtoasuccessfulZeroRoboticsprogram.Discusswhichagencies,

organizations,schools,orotherserviceprovidersyouplantocollaboratewithonthisproject.Ifyouhaveacommitmentfromthesepartners,havetheyagreedtoprovidevolunteers,financialsupport,oranotherformofsupport?Ifyouhavenotyetengagedpartners,pleaseexplainwhyand/oryourplantodoso.

· IfyouhaveparticipatedinZeroRoboticsinthepast,letusknowwhatyouthoughtofit.Shareanysuccess

storiesyoumighthavehad. ZeroRoboticsApplication:MiddleSchool2017SummerProgram Page4

PARTIII:RequiredCommitment Bysigningbelow,youconfirmthatyourprogramagreestoprojectcommitments:

______________________________________________agreestothefollowing: Organization/Schoolname

· Myprogramwillserve10-20youthfor5weeksofthesummerforaminimumof15hoursperweek(includingfieldtrips).

· Myprogramagreestotargetunderservedandunderrepresentedyouthforthis

program.

· Myprogramhasenoughcomputersforyouthtoaccess,utilize,andlearnonoverthesummer.

· MyprogramwillidentifyandhireaZeroRoboticsCurriculumCoordinator(also

knownasyourteacher,mentor,orspecificeducatorleadingstudentsthroughthecurriculum)whowillcommittoattendeducatortrainingsessions,coordinatetheZeroRoboticsprogram,andserveasthemainprogramsitecontact.

· Myprogramwillcoordinatetransportationtoanall-competitorFieldDayinthe

secondweekoftheprogram.

· Myprogramagreestocoordinatetransportationandauthorization/permissionformsforyouthandfamiliestoattendthefinalISSCompetitioninthemiddleofAugust.

· MyprogramwillcommunicateregularlywiththestatecoordinatorsandZeroRoboticsteam.

· Theeducators,mentorsandvolunteersagreetoprovidewrittenfeedbackon

curriculumdesignandeaseofusetotheZeroRoboticsteam.

· Myprogramagreestohavestudentsandeducatorscompleteallpre-/post-evaluationsinatimelymanner.

· Myprogramwillshareoursummerstorywithlocalnewsoutlets. · Ourprogramwillengagefamiliesthroughoutthefive-weekprogram.

· Ourstaffagreestohavefunandlearnalongsideourstudents!

Signed:__________________________________________________Date:____________________

AuthorizedSignature