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KI Excellence Initiative Checklist - Kairos

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Institutional Name: ___________________________<br />

Date: ______________________<br />

<strong>Kairos</strong> Inside <strong>Excellence</strong> <strong>Initiative</strong><br />

<strong>Checklist</strong><br />

WL: ___________________________<br />

AL: ___________________________<br />

KAIROS INSIDE EXCELLENCE INITIATIVE CHECK LIST TALLY SHEET<br />

SCORING THE COMPLIANCE CHECKLIST:<br />

AREA MAX<br />

SCORE<br />

REMARKS IF NECESSARY Actual %<br />

SCORE<br />

I 40<br />

0%<br />

II 20<br />

0%<br />

III 16<br />

0%<br />

IV 27<br />

0%<br />

V 10<br />

0%<br />

VI 10<br />

0%<br />

VII 10<br />

0%<br />

VIII 20<br />

0%<br />

IX 50<br />

0%<br />

X 66<br />

0%<br />

XI 44<br />

0%<br />

XII 26<br />

0%<br />

XIII 22<br />

0%<br />

SIGNED: __________________________________________________________________________________________ _____________<br />

State Chair or Designee<br />

DATE:<br />

PRINTED:<br />

_________________________________________________________________________________<br />

p. 8 of 8 <strong>KI</strong> <strong>Excellence</strong> <strong>Initiative</strong> 03/19/2011

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