UEIN Conference Application

* Required

Registration fee, transportation and hotel accommodations will be the responsibility of the participant. In order to make this a quality experience for all participants the number of attendees will be limited. Applications will be reviewed on a first come, first serve basis.

Organization:

* Contact Person:

First Name

Last Name

* Address:

Address 2:

* City:

* State:

* Zip:

Telephone:

Area Code Phone #

Fax:

Area Code Fax #

Email Address:

Why are you interested in attending this Urban Education Innovation Roundtable?

From your perspective, how important is it to learn more about each of the following areas in order to improve educational outcomes for all students?

		Essential	Very Important	Important	Might or Might Not Be Important
1.	Create and strengthen small learning communities,
2.	Provide every student and family an effective advocate,
3.	Get all teachers focused on actively engaging all students in rigorous learning activities with payoff on high stakes assessments,
4.	Integrate these three strategies into a data-driven, coherent and sustainable approach to improving student achievement and commitment; and
5.	Build the system leadership capacities needed to support the above.

What level building would each member of your team like to see on the school visits?
(Please choose one from each level – 1 being the highest by order of priority)

	1	2	3		1	2	3		1	2	3
High School				Middle School				Elementary

*
Choose the one that most closely represents your organization
Click the Continue ... button to advance to the selected section

School District

Foundation

State Agency

Federal Agency

Educational Intermediary

Journalist

You may wish to print this page for your records before continuing.

Kansas City, Kansas Public Schools
625 Minnesota Avenue
Kansas City, KS 66101
(913) 279-2311
email paellis@kckps.org
www.kckps.org

Institute for Research and Reform in Education
www.irre.org