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Directions: Fill in this form as applicable to the Teacher Residency Capacity Grant to plan for a Teacher Residency program. Note: You may select any number of the residency programs listed below

1. Estimate the target number of residents by credential or program type for the Teacher Residency Program to be planned under the Capacity Grant. The IHE partner(s) must already have a Commission-approved program for each residency area selected.
Special Education  * 
Special Education with Bilingual Authorization  * 
Single Subject in a STEM Area  * 
Single Subject in a STEM Area that Authorizes Teaching of Computer Science  * 
Single Subject in a STEM Area with Bilingual Authorization  * 
Single Subject Non-STEM with Bilingual Authorization  * 
Multiple Subject (to teach in TK or Kindergarten)  * 
PK-3 ECE Specialist Instruction Credential (to teach in TK or Kindergarten)  * 
Multiple Subject with Bilingual Authorization  * 
PK-3 ECE Specialist with Bilingual Authorization  * 
Dual Credential  * 
Please specify the two credentials here:


Diversifying Teacher Workforce that Reflects the LEA Community’s Diversity – Special Education  * 
Diversifying Teacher Workforce that Reflects the LEA Community’s Diversity – Multiple Subjects and/or PK-3 ECE with or without added authorizations  * 
Diversifying Teacher Workforce that Reflects the LEA Community’s Diversity – Single Subjects with or without added authorizations  * 

2. LEA(s) and school sites where the residents would be placed during implementation of the Teacher Residency Program developed under the Capacity Grant.
Please enter with the following format with each LEA(s) on a new line: LEA(s) - School(s) for Resident Placement - Number of Residents Annually - Residency Area

3. Partner IHE(s) for the Teacher Residency Capacity Grant. Please add rows as necessary
Please enter with the following format with each Partner IHE on a new line: Partner IHE - Residency Area