School District:
School Name:
School Website:
PBS District Coordinator:
PBS Coach:
Coach Email:
Coach Phone:
Previous Model School Y/N:
No
Yes
If yes, what was the last school year that you received PBS Model School status?
N/A
2004-2005
2005-2006
2006-2007
2007-2008
Level Awarded
N/A
Bronze
Silver
Gold
Name of person completing this application
Grade levels your school serves
Total number of students enrolled
Percentage (%) of ESOL students
Percentage (%) of free and reduced lunch
Percentage (%) of students with IEP's
Naratives - not to exceed 250 characters
Describe the proactive/preventative strategies utilized that have allowed your
Maximum 250 Characters
What makes your team work so well? What are your overall strengths?
Maximum 250 Characters
What are some obstacles/barriers that your team has overcome?
Maximum 250 Characters
Based upon your data, describe the specific changes your school has
Maximum 250 Characters
2.Supporting Documentation – documents under 2MB to be uploaded
Criteria for becoming a PBS Model School in Florida include all of the following:
written recommendation from a District Coordinator and confirmation recommendation from FL PBS:RtIB Project staff, completed (1) On-Site PBS Walkthrough by a peer PBS Coach or District Coordinator supporting the BoQ score, a high Benchmarks of Quality score indicating fidelity of SWPBS implementation, outcome data (Mid-Year and End-Year Reports) indicating progress, and completed On-Line PBS Model School application & supporting documentation.
*Important Directions: Throughout this application process the size of documents allowed to be uploaded is limited to a maximum of 2MB per document and should be carefully considered prior to submitting. In the fields below, please "Copy & Paste" the exact name of your uniquely titled document so that we may distinguish it from others in the applicant pool. Examples would be "Turner_Rec.doc", or "Pelican_Bay_Walkthrough.doc". You will be prompted to upload these documents on the next page.
Recommendation Letter from your PBS District Coordinator
Completed On-site PBS Walkthrough
Based upon the PBS Model School criteria, please complete the following fields below. Once again, please "Copy & Paste" the exact name of your uniquely titled document so that we may distinguish it from others in the applicant pool. You will be prompted to upload them on the next page. Only complete the fields that you are applying for. For example, if you are applying for Gold Level, you must upload documents that meet the Bronze, Silver, and Gold level criteria.
Bronze:
Silver: meet minimal criteria as stated in the Bronze level, demonstrate higher implementation fidelity, and supporting documentation. Again, "Copy & Paste" the exact name of your uniquely titled documents so that we may distinguish it from others in the applicant pool. You will be prompted to upload them on the next page. Please make sure to provide evidence of at least one of the following:
Office Discipline Referrals disaggregated by race with description
Visibility strategies (families, community, district, etc.)
Political Support Strategies
Established funding supports beyond the FLPBS:RtIB Project
Gold : meet minimal criteria as stated in the Bronze and Silver levels, demonstrate the highest implementation fidelity, and supporting documentation provides evidence of visibility strategies and/or established funding supports across all tiers of Positive Behavior Support (Tier 1/Universal, Tier 2/Supplemental, and Tier 3/Intensive levels of behavior support). Copy & Paste the exact name of your uniquely titled documents so that we may distinguish it from others in the applicant pool. You will be prompted to upload them on the next page.
Copy & Paste exact name of document
Copy & Paste exact name of document
