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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.
1. Complete the following table to indicate both the target number of residents annually and proposed amount of grant funds per resident.
Diversifying School Counselor Workforce that Reflects the LEA Community’s Diversity – Pupil Personnel Services credential specializing in School Counseling
2. Admission, Enrollment, and Clinical Practice Dates
Admission Date: Admission in a grant funded residency program is defined as the date when a candidate
has been formally accepted into both the IHE and the LEA school counselor residency program.
Enrollment Date: Enrollment in a grant funded residency program is defined as the date when a candidate
has been formally admitted into the LEA school counselor residency program and is registered in a required IHE course
for the school counselor residency program. The placement start date with the mentor school counselor may occur after
the formal enrollment date.
Clinical Practice Start Date: Clinical Practice Enrollment in a grant funded residency program is defined
as the date when a resident has been formally assigned to a placement with a mentor school counselor. Note, the start date
of the placement with the mentor school counselor must fall on or before the first day of pupil instruction.
3.LEA(s) and school sites where the residents would be placed.
Applicants may include a range of residents to be placed at an individual school site (e.g., 2-4 residents per year at XYZ school)
if the sum of the maximum numbers in each range is equal to the total residents projected in the first table on this appendix.
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4. Describe the rationale for the selection of the identified resident placement school(s)
5. Partner IHE(s) for the School Counselor Residency Implementation Grant
