Education Leaders Summer Conference Call for Professional Presentations

RPrimary Speaker Name:

RJob Title:

RSchool/Organization:

RAddress:

RCity:

RState:

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware D.C. Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

RZip:

RPhone:

RE-mail:

RIPA Member?

Yes No

RMy organization is best described as (please check all that apply):

Elementary Middle High School Urban Rural Suburban Public Private Parochial Alternative Other

RCurrent enrollment:

1-500 501-1000 1001-1500 1500+

ADDITIONAL SPEAKERS: (Correspondence will only be sent to the Primary Speaker listed above.)

Name:

Title:

School/Organization and City:

IPA Member?

Yes No

Name:

Title:

School/Organization and City:

IPA Member?

Yes No

(If there are more than two additional speakers, please attach another typed sheet with information.)

SESSION FACILITATOR: (Facilitators introduce the speaker and distribute evaluation forms.)

Facilitator Name:

Title:

School/Organization:

School Address:

City:

State:

Zip:

(IPA will select a facilitator for you if none is listed.)

Leadership Competencies (Please check all that apply)

Personal / Wellness Personal / Growth Mindset Personal / Self-Management Personal / Innovation Social / Service Social / Community Building Social / Capacity Building Social / Influence Systems / Mission/Vision Strategic Planning Systems / Operations and Management Systems / Teaching and Learning Systems / Cultural Responsiveness

RSchool level for which your program is appropriate:

Elementary Middle Secondary All

RProgram Title:

Learning Objectives of Session: ("At the end of my session, participants will be able to ...")

1.

2.

3.

R2. Description of Session: Provide a one paragraph description of the presentation. This description will be used as criteria to judge and if accepted, it will be printed in the conference agenda.

R3. What skills or insights will your audience develop or be enhanced by attending your session?

R4. We strongly suggest you have handouts to share with your audience. Please describe what you will have. (Plan on 75 attendees per session)

R5. Have you made this presentation before?

Yes No

If yes, where/when?

R6. IPA will provide an AV Cart, Screen and LCD Projector for each session. Any additional requests?

R7. Please submit a 75 word or less vita for the moderator to introduce you.