2012 National Forum Workshop Application
YOUTH SESSION
Please select your workshop type:
¦ Youth-led Application
Please fill out the following information about the Lead Presenter:
@ Name
@ Title
@ School Name
@ City/Town
@ State/Province
@ Zip/Postal Code
@ Phone Number
@ Email Address
Please add a brief bio about the Lead Presenter listed above:
Please indicate your age:
¦ 13-17
¦ 17-20
¦ 21+ (College Student)
Workshop Title:
SECTION B: IDENTIFYING TARGET AUDIENCE
Please select your target audience. Check all that apply.
q Community Partners—faith-based, community-based, corporate/business community, public and private organizations, health and mental health, and youth and community development
q Community School Coordinators
q Funders—local and national foundations
q Higher Education—colleges and universities, community college leadership/staff, cooperative extension program leadership/staff
q Lead Agencies and Local Intermediaries—United Ways, Community Foundations, YMCAs, Boys and Girls Clubs
q Local Government Leaders—city and county, association chapters, local businesses, community-based organizations
q National Leaders—policymakers, national education, youth development, health and human services
q Parents & Families
q School Leaders and Educators—superintendents, school board members, principals, central office personnel, teachers, student support staff
q State Leaders—policymakers, state education leaders/staff, organizations, associations, community-based organizations
q Youth—high school and university students
q Other, please specify
SECTION C- Level of Community School Development (Select all that apply)
We want to reach people who are in different stages of developing their community schools. Please consider whether your workshop is most appropriate for people who are:
q Inquiring: Heard about community schools; want to know more
q Planning: In midst of planning process
q Emerging: Just getting services and programs off the ground
q Maturing: Solid base of experience; ready to face challenges that scale-up to more sites
q Established: Successfully scaling up; need to ensure continuous improvement
Teaching Format (Select all that apply)
Please identify the teaching format(s) and primary goal of your workshop:
q Skill Building
q Dialogue
q Case Study
SECTION D- DESCRIPTION
Brief Workshop Description – <50 words (Used for program book and online)
Full Workshop Description – <500 words. This description must include the learning objectives, methodology, as well as examples of how this session will be interactive. (Used for review by selection panel)
Will your session include additional session speakers?
¦ Yes
¦ No
Please fill out the following information about the additional session speaker- Presenter 2:
@ Name
@ Title
@ Organization/School Name
@ City/Town
@ State/Province
@ Zip/Postal Code
@ Phone Number
@ Email Address
Is this presenter a youth?
¦ Yes
¦ No
Please fill out the following information about Presenter 3:
@ Name
@ Title
@ Organization/School Name
@ City/Town
@ State/Province
@ Zip/Postal Code
@ Phone Number
@ Email Address
Is this Presenter a youth?
¦ Yes
¦ No
Please fill out the following information about Presenter 4:
@ Name
@ Title
@ Organization/School Name
@ City/Town
@ State/Province
@ Zip/Postal Code
@ Phone Number
@ Email Address
Is this Presenter a youth?
¦ Yes
¦ No
Add an additional session speaker?
¦ Yes
¦ No
Please fill out the following information about Presenter 5:
@ Name
@ Title
@ Organization/School Name
@ City/Town
@ State/Province
@ Zip/Postal Code
@ Phone Number
@ Email Address
Is this Presenter a youth?
¦ Yes
¦ No
SECTION E- LOGISTICS NOTE: LCD projectors and laptops will NOT be provided by the Coalition. Presenters who need an LCD and screen MUST make their own arrangements
Audio/Visual Needs Please select all equipment needed:
q Flip Charts/Markers (only one flip chart will be provided per workshop)
q Overhead Projector and Screen
q Screen Only
q No A/V Needed
Room Set Up Please indicate your preference. We will try to accommodate all requests.
¦ Classroom Style
¦ Theatre Style
¦ Banquet Rounds
Thank you for submitting your 2012 National Forum workshop proposal. We look forward to seeing you in May!