Page 1 of 6 OMB No. 3170

- XXXX Expiration: XX/XX/20XX



## Teacher Training Initiative District Application

The Consumer Financial Protection Bureau ( CFPB ) is seeking to partner with local education agencies (LEA s ) to design and implement a Teacher Training I nitiative (TTI) in the area of K

- 12 financial education

. T he goal of the TTI is to improve and sustain youth financial capabilit ies by training teachers to teach and/or incorporate financial education concepts into their curricula

. Each partnering LEA will participate in two training years during which teachers will receive training ( including appropriate

resour ce materials ) and training follow

- up ( including participation in a national financial education convening and access to a community of train ed teacher )

.

Interested LEAs are invited to submit this District Application . All responses must be submitted in

w riting, via email by XXXX, 5:00 pm EST to xxx@cfpb.gov . Responses should be limited to a maximum of five pages of supplemental information

.

APPLICATION :

I. GENERAL INFORMATION Local Education Agency (LEA) Name

____________ ______________ Address

__________________________________________________ City________________________State____________Zip__________
Superintendent

____________________________________________ Email________________________Phone__________________

__ ___ LEA Contact Person

________________________________________ Title_______________________________________________

______ Department_________________________________________

______ Contact Person email__________________Phone__________

_______ Grades included in the LEA

__________________________________ Number of schools in LEA

___________________________________ Number of Title I schools in LEA

______________________________ Percent age of total student population eligible for free or reduced lunch

_________ Number of teachers in LEA_

________________________________Page 2 of 6 Anticipated number of teachers who would receive financial literacy training

________________________________________________________

II. FINANCIAL EDUCATION

1. Please indicate if you r LEA has a financial literacy requirement as evidenced by (check
all that apply) :

_____ Personal finance instruction is a high school graduation requirement either as a
standalone course or as part of another course that is required.

_____ State pers onal finance standards are completed and your LEA is required to
implement the standards.

_____ Student testing of personal finance concepts is required.

_____Other ________________

_____________________________________

_______________________________________________________________ _____We do not have a financial literacy requirement at this time.

2. Is a financial education component included in your curriculum for the 2014

- 2015 school
year? ___Yes ___No
If yes, what financial education curriculum are you currently using? In which grades?

________________________________________________________________________

____________________________________________________________

3. What academic department manages the financial education instruction? If more than
one department manages financial education instruction, please indicate this by checking
all that apply

. _____ Social Studies

_____ Math
_____ Language Arts
_____ Family and Consumer Science

_____Other: ___________________________Page 3 of 6 4. For how many years has your LEA included some form of financial education in your

school curriculum?___

_________________________________________________ In what year did you first include financial education in the curriculum?

________

5. If your LEA is not currently providing financial education as part of the curriculu m:

a. Has the senior management of your LEA engaged in conversations about
participating in financial education dur ing the last two years?

___ Yes

___No

b. Has your LEA engaged in such conversations with key stakeholders, including:

• The School Board __Yes __No

• Senior Administration (of the LEA) __Yes __No

• Teacher’s Union __Yes __No

• Parent Organizations __Yes __No

c. Will you be able to produce letters of support from any of the ab ove stakeholder s ? If
so, please indicate which one ( s ) :
___ School Boa rd

___ Senior LEA A dministration

___ Teacher’s Union
___ Parent Organizations

III. PROFESSIONAL DEVELOPMENT

1. When does your professional development usually take pla ce ? (check all that apply )

_____ after school

______before school

______ during the school day

______ during a professional development day

______ during the summer

2. Has your LEA worked with external vendors to provide teacher professional
development in the past?
If so, please describe a recent example.Page 4 of 6 __________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

3. Please expl ain your plan for recruiting teachers for the financial education teacher
training . Please note that we will require a minimum of 100 teachers in each of the two
training years, more if possible. (An exception to the 100 teacher minimum will be

consid ered in special cases )

_________________________________________________________________

_________________________________________________________________

____________________________________ _____________________________

____________________________________ _____________________________

IV. IMPLEMENTATION :

1. Who will be managing the t eacher training for the LEA ?
Name:______________________ Department:_______________________

Email:______________________ Phone: ___________________________

2. How will your LEA ensure that the teachers utilize the financial education teacher
training ?

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

3. What types of technology are available in your LEA for both the training and the

im plementation in the classroom?

________________________________________________________________

________________________________________________________________Page 5 of 6 4. Is it possible to communicate regularly with teachers through email, web

, or social media

, such as Facebook or LinkedIn? ____Yes ____No.

• If no, how can CFPB reach the teacher s on a regular basis ?

____________________________________________________________

____________________________________________________________

____________________________________________________________

5. Does your LEA agree to work with the CFPB to develop a plan for sustainin g the
program after the treatment years

, which may include a train

- the

- trainer model? ____Yes

____No

V. EVALUATION
We would like some information about your ability to participate in the evaluation component of our program. No personally identifiable information (PII) will be obtain ed during the program, or included in information shared later with other parties.

1. Is your LEA willing to partner with CFPB to gather data of financial education skills

, from both students and teachers, at the onset of the training, and after the training is

concluded ? ___ Yes ___ No

2. Will your LEA allow the students and teachers to be surveyed about their experiences
participating in this program? ___ Yes ___ No

3. Will your LEA agree to share i nformation obtained during the evaluation process with

other LEAs, with financial education professional s, and with the public? Please note that

n o personally identifiable information will be obtained during the program, or included in

inf ormation shared later with other parties

. ___ Yes ___ No

4. Is your LEA willing to share knowledge of the curriculum implementation and student

achievement with other LEAs

, and with professionals i n the financial education field , by
participating in peer lea rning activities ? ___ Yes ___ NoPage 6 of 6 P rivacy Act Statement

5 U.S.C. 552(a)(e)(3)
The information you provide will be used to assess local education agencies (“LEA”) for participation in the Consumer Financial Protection Bureau’s (“CFPB”) Tea cher Training Initiative (“ TTI”)

.
Information collected on behalf of the CFPB will be treated in accordance with the System of Records Notice (“SORN”), CFPB.021

– Consumer Education and Engagement Records , 77 FR 60382. This information will not be disclosed as outlined in the Routine Uses for the SORN , with the exception of disclosure to the Bureau’s selected contractor for implementing the program . Di rect identifying information

, including your contact information, will only be used to facilitate communication between the CFPB and your LEA regarding participation in the MTTI, and will be kept private except as required by law. However, the CFPB may hav e information about LEAs, without personal identifiers publicly available as part of a report or similar publications.

This collection of information is authorized by Pub. L. No. 111

- 203, Title X, Sections 1013 and 1022, codified at 12 U.S.C. §§ 5493 and 5512.

Participation is voluntary, you are not required to provide any identifying information, and you may withdraw participation a t any time. However, if you do not include the requested information, the CFPB may not be able to consider your LEA for part icipation in the MTTI

.

Paperwork Reduction Act According to the Pap erwork Reduction Act of 1995, a Federal agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control num ber. The OMB control number for this collection is 3170

- XXXX

. It expires on MM/DD/YYYY . The time required to complete this information collection is estimated to average approximately 60 minutes per response. Responding to this information collection is voluntary; however, a completed application is required for an LEA to be considered for participation in the MTTI. Comments regarding this collection of information, including the estimated response time, suggestions for impr oving the usefulness of the information, or suggestions for reducing the burden to respond to this collection should be submitted to Bureau at the Consumer Financial Protection Bureau (Attention: PRA Office), 1700 G Street NW, Washington, DC 20 552, or by email to PRA@cfpb.gov

.