Peer-to-Peer Practice Submission Form

Institution: Name of the Institution

Demographics

Primary Contact Information

Secondary Contact Information

Phone Number*

Phone Number*

E-mail Address*

E-mail Address*

Public/Non-public			Alternate Beginning Grade
School Type			Alternate Ending Grade
Charter School			Enrollment
Location Type			Gender at School
Beginning Grade
Ending Grade

Practice

1. Name of Peer-to-Peer Practice*

2. Primary Contact Name*

3. School Name*

4. Submission Date

5. Description of this practice: Briefly describe what you were trying to accomplish; how it was implemented; and what evidence you have that it worked.*

6. Reason for practice: Describe the problem(s) or need(s) you addressed with this practice.*

7. Subject Area(s): Choose all the areas to which this practice applies.*

		Not Applicable			Science
		Interdisciplinary			Social Studies/History
		Schoolwide			Health/Physical Education
		Reading (English/Language Arts)			World/Foreign Languages
		Writing (English/Language Arts)			Career/Technical Education
		English/Language Arts - Other			Fine Arts
		Mathematics			Extracurricular
		Other (Please Specify)

8. Grade level(s) of the students targeted for this practice. Choose all the grade levels that apply.*

Not Applicable	3	9
All Students	4	10
PreK	5	11
K	6	12
1	7	13 or higher
2	8

9. Group(s) of students targeted for this practice. Choose all groups that apply.*

		Not Applicable
		All Students
		Specific Ethnic Group
		Free or Reduced Lunch
		IEP or Special Education
		LEP or Limited English
		Advanced
		Other (Please Specify)

10. Group(s) of adults targeted for this practice. Choose all groups that apply.*

		Not Applicable		Custodial and Maintenance Staff
		Administrators and Supervisors		Food Services Staff
		Classroom Teachers		Security Staff
		Professional Support Staff		Parents
		Aides		Community Members
		Secretarial and Clerical Staff
		Other (Please Specify)

11. Choose the length of time this practice was implemented.*

		Less than 1 school year
		1 - 3 school years
		4 - 6 school years
		More than 6 school years

12. Resources: Briefly describe the essential human, material, and financial resources needed to implement this practice.*

Optional: Indicate any specific material resources or tools that support this practice.

Resources and Tools

	Content Id	Name	Date	Status

13. Research: Identify any research you are aware of that supports this practice.

14. Conclusion: Describe your next steps in implementing this practice.*

15. Contact Information: Please provide primary and secondary contact information so that other practitioners may contact you.

Institution Name

Institution Web Address

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