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SEL Resource Pilot Sign-Up

Thank you for your interest in piloting the Social and Emotional Learning Resources for 1st-3rd grade. Please complete the survey below to indicate your interest. More information will be provided in the coming weeks.

A Pilot Introduction Webinar will be presented multiple times, starting with webinars on Friday October 18th at 10 a.m. and Monday, October 21st at 1 p.m.,with additional dates later this fall. Please register here if you have any questions.

Questions regarding the pilot may be addressed to Jane Haltiwanger at jhaltiwanger@doe.mass.edu.

1. Please enter contact information for one person from the pilot site *This question is required.

First Name

Last Name

Title/Role

Organization/Program/School

District

2. Email Address *This question is required. This question requires a valid email address.

3. Re-enter Email Address *This question is required. This question requires a valid email address.

4. Review Participation Information

	Yes	No	Yes	No	Number of staff/classrooms reviewing or piloting
	Staff will review		Staff will pilot in their classroom		Number of staff/classrooms reviewing or piloting
Grade 1	Grade 1: Staff will review: Yes	Grade 1: Staff will review: No	Grade 1: Staff will pilot in their classroom: Yes	Grade 1: Staff will pilot in their classroom: No	Number of staff/classrooms reviewing or piloting
Grade 2	Grade 2: Staff will review: Yes	Grade 2: Staff will review: No	Grade 2: Staff will pilot in their classroom: Yes	Grade 2: Staff will pilot in their classroom: No	Number of staff/classrooms reviewing or piloting
Grade 3	Grade 3: Staff will review: Yes	Grade 3: Staff will review: No	Grade 3: Staff will pilot in their classroom: Yes	Grade 3: Staff will pilot in their classroom: No	Number of staff/classrooms reviewing or piloting

5. Check below to indicate which SEL resources you wish to pilot or review:

6. Check which pilot options are of interest

Pilot option 1: Content review/ written feedback only
Pilot option 2: Pilot by trying out activities and/or supportive practices
Pilot option 3: Mixture: Content review/feedback AND Pilot tryout of activities and/or supportive practices

7. Expected Month to begin Pilot: (check one or more)