Illinois Middle Grades Network - EXPLORATION APPLICATION

School Name:

Address:

City:

State:

ZIP Code:

Principal's First Name:

Principal's Last Name:

Principal's Email:

Grade Levels:

Enrollment:

District Name:

District Address:

City:

State:

ZIP Code:

Other middle schools in district (please list):

Direct Superintendent's First Name:

Last Name:

Superintendent's Email:

Please attach the following information with your application. Your application cannot be processed without these.

Teacher schedules
School Report Card
Mission Statement and School Improvement Plan
Program Narratives in sufficient detail to give understanding of school’s program and structure
Letter of Staff Support (at least 75% support level)
Rationale for Participation in the Project
- Why do you believe your school should be selected as a Network school for the Illinois Middle Grades network? (Not to exceed one typewritten page.)

Required Official Signatures

Contact Person __________________________ Date_______________
Principal _______________________________ Date_______________
Superintendent __________________________ Date_______________
School board notified of submission of application and the commitments of Network membership on Date_______________

Please designate your two complimentary memberships

Member One

First Name:

Middle Initial:

Last Name:

Position:

Grade Level:

Subject:

Member Two

First Name:

Middle Initial:

Last Name:

Position:

Grade Level:

Subject:

Billing Information

Payment options:

Address if different from above:

Address:

City:

State:

ZIP Code:

When you complete the form you will be redirected to an online payment page. If you would rather not pay online, please print this form (by clicking the printer icon below) and mail it to AIMS with your payment.

AIMS
University of Illinois Champaign-Urbana
510 Devonshire Drive
Champaign, IL 61820

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Important Dates

IMG Network - Exploration Application