Los Angeles Unified School District



NAME _____Amelia Emerson Emp. # __12345678__________ Local District ___ East PAGE NO. __17__

National Board Certified Teacher 92 Hour Program

ACTIVITY LOG 2016-17

TASK 10d: Other Activities—separate form required for each Task 10 Activity requested

Written Pre-Approval from NBCT Liaison Required

| |USE A SEPARATE PAGE FOR EACH TASK 10 ACTIVITY—EMAIL PRE-APPROVAL MUST BE SUBMITTED WITH LOG |

| | |

| |NBCTs are responsible for reading and understanding the guidelines and documentation for each Task for the current year as posted on the Website: . Contact your NBCT Liaison if |

| |you need assistance. |

| |Administrator/UTLA Officer (if activity is for UTLA) initials each to Certify then signs the bottom of the form: |

| |___ The work is beyond the scope of responsibilities expected of the NBC teacher, other teachers performing similar duties are being paid |

| |___ The activity is in alignment with current District priorities/initiatives |

| |___ The hours indicated are not for work with students, supervision of students, or materials management/distribution |

| |___ The hours are for an LAUSD or UTLA office—work for outside agencies or vendors ineligible for NBC compensation |

| |___ Development of curriculum for students limited to district-wide work to align curriculum to new initiatives or the needs of special populations students |

| | |

| |Activity: Create a new intervention program including parent and student workshops & support as well as recruiting mentors for specifically identified students |

| |Rationale: We have a high percentage of students at risk of not being on track to gain either college or career readiness skills, much less both. We would like to create an innovative program where |

| |students can attend intervention classes that focus on a variety of skills, both academic and social. A key component is recruiting mentors from the community who can build a bond with identified students |

| |and provide guidance. There will also be a parent component that will help parents build the skills to support their children. |

| |Although the school will be able to maintain the program once it is developed we want to use NBC hours for two NBCTs to develop it and recruit mentors. |

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| |Administrator/UTLA Officer Name ____R. Carter_____________________________ Signature____ R. Carter |

| |_________________________________ |

|TASK |ACTIVITY LOCATION |Task Description |Dates/Hours Worked |Administrator/UTLA Officer Signature |

| | | | | |

|10 |Pyramid ES |Developed student identification procedures, intervention program processes, initial |Wed/Thu afternoons July – Dec. |Title: Principal |

| | |curriculum. Developed screening process for mentors, recruited the first cohort and matched|Implementation Thursday | |

| | |them with students. Developed parent curriculum. Began implementation of the program. |afternoons 2nd sem | |

| | |Recruit, train and monitor staff. Coordinate program. | |Signature: R. Carter |

| | | | | |

|Total Hours This Page |50 | |

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Be sure to read all task 10 guidelines carefully and get pre-approval.

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