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Educator Preparation Contact Information Form

Overview

The Educator Preparation Team at the Department of Elementary and Secondary Education (ESE) requires all currently approved Sponsoring Organizations to maintain an up-to-date set of contact information with the Department. This is particularly important given the evolving nature and content of communications being sent out to Sponsoring Organizations on a regular basis.

We ask that each individual organization carefully review and asses their internal communications structures to ensure that information is shared and distributed accordingly. For detailed information about the roles outlined in this survey, please see: www.doe.mass.edu/edprep/resources/advisories

1. Sponsoring Organization

2. Name of Individual Completing this Form

ESE asks that the contacts outlined be designated by the individual in charge of the Sponsoring Organization's Educator Preparation programs (Ed Prep Decision-maker or SO Leader). *This question is required.

First Name

Last Name

Title

Email Address

Phone Number

3. Primary Contact

The Primary Ed Prep Contact, as designated by each individual SO:

Receives all communication from the Ed Prep Team
Is expected to distribute the communication to relevant parties within each organization in a timely manner
Is the point of contact for any inquires or questions from the SO to ESE and is responsible for coordinating and communicating answers received
Should be someone with the necessary authority and oversight within your organization to effectively support communication. To this end, we suggest that you select someone as the primary contact that:
- can easily and quickly share information with the right people
- has a breadth of knowledge about individual programmatic features of your organization
- is a connector at your organization and a strong liaison between ESE and individuals in your institution

*This question is required.

First Name

Last Name

Title

Email Address

Phone Number

4. Ed Prep Decision Maker

Likely the Dean or the Executive Director, this individual has direct authority over licensure programs within your SO. This individual can expect to receive minimal communication (unless also identified as the primary or secondary contact) and will only be included on emails associated with significant announcements. *This question is required.

First Name

Last Name

Title

Email Address

Phone Number

5. SO Leader

In smaller organizations, this person may be the same person as the Ed Prep Decision Maker. In larger, traditional Institutes of Higher Education for instance, this is likely your President/Provost/Chancellor. This individual receives the least amount of communication and is primarily contacted to announce and conclude a period of review. *This question is required.

First Name

Last Name

Title

Email Address

Phone Number

6. Optional Roles for more Targeted Communication:

In addition to updating contact information for the required roles above, ESE also collects information for individuals in more specialized roles. This helps further target communication. As a reminder, these roles are in addition to the Primary contact who will, regardless of the targeted communications to these roles, receive all communications.

For a full description of the types of communications individuals in these roles might expect, see the Serving as an Ed Prep Contact advisory.

Please indicate whether your organization would like to add a contact for any of the roles below. If you indicate that you would like to add contact information for a specific role, the space to do so will appear further down in the form.

Space Cell	Not applicable to our SO at this time	Yes, we would like to identify an individual for this role	This individual is the same as our Primary Contact
Secondary Contact	Secondary Contact: Not applicable to our SO at this time	Secondary Contact: Yes, we would like to identify an individual for this role	Secondary Contact: This individual is the same as our Primary Contact
Field-based Experiences Contact	Field-based Experiences Contact: Not applicable to our SO at this time	Field-based Experiences Contact: Yes, we would like to identify an individual for this role	Field-based Experiences Contact: This individual is the same as our Primary Contact
Licensure Contact	Licensure Contact: Not applicable to our SO at this time	Licensure Contact: Yes, we would like to identify an individual for this role	Licensure Contact: This individual is the same as our Primary Contact
Data Contact	Data Contact: Not applicable to our SO at this time	Data Contact: Yes, we would like to identify an individual for this role	Data Contact: This individual is the same as our Primary Contact
PK12 Partnership Contact	PK12 Partnership Contact: Not applicable to our SO at this time	PK12 Partnership Contact: Yes, we would like to identify an individual for this role	PK12 Partnership Contact: This individual is the same as our Primary Contact
Arts Contact	Arts Contact: Not applicable to our SO at this time	Arts Contact: Yes, we would like to identify an individual for this role	Arts Contact: This individual is the same as our Primary Contact
History and Social Science Contact	History and Social Science Contact: Not applicable to our SO at this time	History and Social Science Contact: Yes, we would like to identify an individual for this role	History and Social Science Contact: This individual is the same as our Primary Contact
ELA and Literacy Contact	ELA and Literacy Contact: Not applicable to our SO at this time	ELA and Literacy Contact: Yes, we would like to identify an individual for this role	ELA and Literacy Contact: This individual is the same as our Primary Contact
Mathematics Contact	Mathematics Contact: Not applicable to our SO at this time	Mathematics Contact: Yes, we would like to identify an individual for this role	Mathematics Contact: This individual is the same as our Primary Contact
Digital Literacy and Computer Science Contact	Digital Literacy and Computer Science Contact: Not applicable to our SO at this time	Digital Literacy and Computer Science Contact: Yes, we would like to identify an individual for this role	Digital Literacy and Computer Science Contact: This individual is the same as our Primary Contact
Science and Technology Contact	Science and Technology Contact: Not applicable to our SO at this time	Science and Technology Contact: Yes, we would like to identify an individual for this role	Science and Technology Contact: This individual is the same as our Primary Contact
Comprehensive Health Contact	Comprehensive Health Contact: Not applicable to our SO at this time	Comprehensive Health Contact: Yes, we would like to identify an individual for this role	Comprehensive Health Contact: This individual is the same as our Primary Contact
World Languages Contact	World Languages Contact: Not applicable to our SO at this time	World Languages Contact: Yes, we would like to identify an individual for this role	World Languages Contact: This individual is the same as our Primary Contact

Secondary Contact

First Name

Last Name

Title

Email Address

Phone Number

Field Placement Contact

First Name

Last Name

Title

Email Address

Phone Number

Licensure Contact

First Name

Last Name

Title

Email Address

Phone Number

Data Contact

First Name

Last Name

Title

Email Address

Phone Number

PK12 Partnership Contact

First Name

Last Name

Title

Email Address

Phone Number

7. Please indicate which programs you are currently approved to offer at your organization *This question is required.

Initial Teacher (any subject and level)
Professional Teacher (any subject and level)
Administrative Leadership
Professional Support Personnel
Specialist (e.g. Reading Specialist)

8. Arts Contact

First Name

Last Name

Title

Email Address

Phone Number

8. History and Social Science Contact

First Name

Last Name

Title

Email Address

Phone Number

8. ELA and Literacy Contact

First Name

Last Name

Title

Email Address

Phone Number

8. Mathematics Contact

First Name

Last Name

Title

Email Address

Phone Number

8. Digital Literacy and Computer Science Contact

First Name

Last Name

Title

Email Address

Phone Number

8. Science and Technology Contact

First Name

Last Name

Title

Email Address

Phone Number

8. World Languages Contact

First Name

Last Name

Title

Email Address

Phone Number

8. Comprehensive Heath Contact

First Name

Last Name

Title

Email Address

Phone Number