Education Leaders Fall Conference Call for Professional Presentations
Education Leaders Fall Conference Small Group Session Proposal Form Springfield, IL - October 16 - 18, 2016
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Primary Speaker Name:
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Job Title:
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School/Organization:
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Address:
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City:
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State:
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
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Zip:
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Phone:
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E-mail:
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IPA Member?
Yes
No
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My organization is best described as (please check all that apply):
Elementary
Middle
High School
Urban
Rural
Suburban
Public
Private
Parochial
Alternative
Other
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Current 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:
Email Address
IPA Member?
Yes
No
Name:
Title:
School/Organization and City:
Email Address
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.)
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Leadership Competencies (Please check all that apply)
Leadership
Operations & Management
Parent & Community Engagement
Climate & Culture
Teaching & Learning
Vision & Strategic Planning
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School level for which your program is appropriate:
Elementary
Middle
Secondary
All
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Program Title:
Learning Objectives of Session: ("At the end of my session, participants will be able to ...")
1.
2.
3.
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Program Abstract 1. Are you focused on an outcome or a process? Please explain.
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2. Description of Session: Provide a one paragraph description of the presentation. This description will be used as criteria to judge.
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3. What skills or insights will your audience develop or be enhanced by attending your session?
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4. We strongly suggest you have handouts to share with your audience. Please describe what you will have. (Plan on 75 attendees per session)
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5. Have you made this presentation before?
Yes
No
If yes, where/when?
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6. Basic audio visual equipment will be provided upon request. Please indicate what you need for your presentation.
Flip Chart
TV/VCR
Microphone
Podium
Head Table
None
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7. Please submit a 75 word or less vita for the moderator to introduce you.
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8. Please provide a 100 word description of your presentation. If your presentation is accepted, this description will be printed in the conference agenda.