Appendix D - Program Summary

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Note: Carefully read and follow the directions to complete the form and generate a PDF version that can be attached to the final application. All narrative responses and PDF appendices must be submitted as one application.

Directions: Fill in this form as applicable to the School Counselor Residency Capacity Grant to plan for a School Counselor Residency program. Note: This form may be expanded if additional pages are needed.

1. Estimate the target number of residents by credential for the School Counselor Residency Program to be planned under the Capacity Grant. *

Residency Area
Diversifying School Counselor Workforce that Reflects the LEA Community’s Diversity – Pupil Personnel Services credential specializing in School Counseling

2. LEA(s) and school sites where the residents would be placed during implementation of the School Counselor Residency Program developed under the Capacity Grant. Please add rows if needed.
Enter with the following format, with each LEA on a new line: LEA - School - Number of residents Annually - Student to Counselor ratio by School Site

3. Partner IHE(s) for the School Counselor Residency Capacity Grant
Enter each IHE Partner on a new line

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