2021-2022 Application to Participate in the MiMTSS Early Childhood Model Demonstration Project

Thank you for your interest in partnering with the MiMTSS Technical Assistance Center (formerly Michigan's Integrated Behavior and Learning Support Initiative; MIBLSI).

Application Timeline

May 3, 2021 Applications are due (entered online by 5:00 p.m. EST).
May 17, 2021 Applicants are notified of the potential partnership.
May 24-28, 2021 Conversations with potential sites to discuss their application, answer additional questions, and mutually determine if the model demonstration project is a good fit. These meetings will clarify the work and expectations.

How to Complete the MiMTSS Early Childhood Model Demonstration Project Application

Selection: Select the applicant level (Intermediate School District or School District) for which you are applying. As you progress, keep in mind that the application system does not accept tables or other formatting (i.e., bold, underline, italics, bulleted list).
Save and Continue Later: Applicants can save progress and return to the survey at a later time. The button to do this is located at the top of each application page. Note that any information entered on a single page can only be saved upon clicking Next first. When you click on "Save and Continue Survey Later," you will be prompted to enter your email address. The system will then send you a specific link to use to access your saved results.
Submission: When you click submit at the end of this application, your responses will immediately be sent to the MiMTSS Technical Assistance Center. The primary contact will also receive an email from Alchemer with a copy of the completed application attached.

If you have questions about the application process, please contact:

Michelle McQueen, M.A. (MDE MTSS Regional Consultant) for questions about potential participation (mmcqueen@mimtss.org)
Cheyne LeVesseur, Ph.D. (Research and Evaluation Specialist) for questions about this application survey (clevesseur@mimtss.org; 248.425.8931)

PRIMARY CONTACT: This person will receive notification of potential partnership and next steps. *This question is required.

First Name

Last Name

Title

ISD/District Name

Email Address

Phone

Intermediate School District (ISD) Applicant

ISD GSRP Program Site

ISD GSRP Site Name:
Number of Program Site Classrooms:
Early Childhood Contact Name:
Phone:
E-mail address:

Intermediate School District Administrator

Administrator/Director:
Phone:
E-mail address:

ISD MTSS Coordinator, if applicable

Name:
Phone:
Email:

Other Program Administrator, as necessary

Name/title:
Phone:
E-mail Address:

School District Applicant

School District GSRP Program Site

School District GSRP Program Site Name:
Number of Program Site Classrooms:
Building Administrator Name:
Phone:
E-mail address:

School District Early Childhood Director/Coordinator

Name:
Phone:
E-mail address:

District MTSS Coordinator, if applicable

Name/title:
Phone:
Email:

Other Program Leader

Name/title:
Phone:
E-mail Address:

Intermediate School District

Early Childhood Contact Name:
Phone:
E-mail address: