Summit Breakout Session Proposal

Thank you for your interest in submitting a Summit Breakout Session Proposal. Please make sure you have read through all of the requirements, selection criteria and terms and conditions before completing the form. If you have any questions, please email: .

By submitting this proposal, you confirm the following*
To view the "Terms & Conditions" page, please visit[1]:

I understand that by submitting this form, I acknowledge and agree that The Microcredit Summit Campaign (a project of RESULTS Educational Fund) shall own all rights of all work performed and material created by this agreement for all purposes under the Copyright Act.
I agree to all the requirements outlined in the "Terms & Conditions" page.

Please send this completed proposal to with the subject "BREAKOUT SESSION PROPOSAL."

Required questions *

Session Organizer’s Contact Information

First (Given) Name*
______

Last Name (Surname)*
______

Organization*
______

Position*
______

Country*
______

Email*
______

Phone number*
Format: (Country Code) (Local Code) (Phone Number)
______

Skype

______

Twitter handle

@______

What languages do you speak?*

Native / Advanced (professional level) / Would need an interpreter
English / ______/ ______/ ______
French / ______/ ______/ ______
Spanish / ______/ ______/ ______
Arabic / ______/ ______/ ______

What stakeholder group do you belong to?*
Please visit the Campaign website to see the Council descriptions to see which group you best fit into:

_____Microfinance Practitioners & Associations

_____Policymakers & Regulators

_____Advocates & Support Organizations

_____Funders & Investors

_____Researchers & Academic Institutions

Would you be interested in learning more about how you can make a Campaign Commitment?*
To learn more about Campaign Commitments and the 100 Million Project pleasevisit:

_____Yes!My organization launched a Campaign Commitment that will be featured in 2015.
_____My organization launched a Campaign Commitment at the 2014 Summit and would
like to renew with a Commitment for 2015.
_____My organization would like help forming a Campaign Commitment.
_____My organization is not ready to make a Campaign Commitment.

Breakout Session Information

Title*
What is the proposed title of your breakout session?

______

Audience*
Who is the proposed audience for your session? Please choose one or more from the groups below.

_____Microfinance Practitioners & Associations

_____Policymakers & Regulators

_____Advocates & Support Organizations

_____Funders & Investors

_____Researchers & Academic Institutions

Audience
If you would like to elaborate on your proposed audience, please do so here.

______

Audience Size*
What is the ideal number of participants for this session?

______

Description*

Outline the topic for your session and tell us how it addresses the issues faced by those living in extreme poverty. From what perspective will you address the topic (i.e., aligned towards practice, policy, research)? (100 words)

Importance/Timeliness*
Why is this an important topic to showcase? How is this timely given the challenges faced by both the sectorand the clients we serve?

Have you organized a session on this topic before?*
redIf yes, please provide the conference name, year, and session title as well as other material, media, or website where we can review the content (if possible).

Proposed session format and session flow

Download the Format & Presentation Guide[2] to learn more about the recommended formats. Indicate which session format you will be implementing for your session. ***Breakout sessions with innovative session formats and engaging learning methodologies will be given preference.

Session format*
Please outline the format, flow, and structure of the session (i.e., number of minutes for each activity, Q&A, etc.). Please keep in mind that the session will be 90 minutes long. Please also reference what equipment, A/V, or seating layout would be needed.

Materials*

What will be the materials that will be produced and made available to participants (i.e. PPTs, case studies, reports, etc.)? Will this be original material? If so, please explain. Please provide the link to existing reports or case studies you are planning to feature at the session.

Outputs*

What will be the expected outcomes, tangible takeaways, and/or the knowledge gained? Please be specific and provide details.

What follow-up activities will you undertake?*
Please select at least one and explain in the following text box

_____Blog/article/paper about this session

_____Follow-up event (in-person or virtual/webinar)

_____Other

Explain follow-up activities*

1 - Presenter Information

Include the presenters that you have in mind for this session. Please note that you do not have to have all the presenters confirmed at the moment you submit this proposal.

First Name (Given) *

______

Last Name (Surname) *

______

Organization*

______

Title*

______

Country*

______

Email(s)*

______

Preferred language (if known)
English, Spanish, French, Arabic

______

Is additional funding NECESSARY?

Please only choose one from the options below.

_____No

_____Funding for flight

_____Funding for hotel

_____Both flight & hotel

Short Bio
If possible, include previous speaking engagements and links to videos of the presenter (YouTube video links).

2 - Presenter Information

Include the presenters that you have in mind for this session. Please note that you do not have to have all the presenters confirmed at the moment you submit this proposal.

First Name (Given) *

______

Last Name (Surname) *

______

Organization*

______

Title*

______

Country*

______

Email(s)*

______

Preferred language (if known)
English, Spanish, French, Arabic

______

Is additional funding NECESSARY?

Please only choose one from the options below.

_____No

_____Funding for flight

_____Funding for hotel

_____Both flight & hotel

Short Bio
If possible, include previous speaking engagements and links to videos of the presenter (YouTube video links).

3 - Presenter Information

Include the presenters that you have in mind for this session. Please note that you do not have to have all the presenters confirmed at the moment you submit this proposal.

First Name (Given) *

______

Last Name (Surname) *

______

Organization*

______

Title*

______

Country*

______

Email(s)*

______

Preferred language (if known)
English, Spanish, French, Arabic

______

Is additional funding NECESSARY?

Please only choose one from the options below.

_____No

_____Funding for flight

_____Funding for hotel

_____Both flight & hotel

Short Bio
If possible, include previous speaking engagements and links to videos of the presenter (YouTube video links).

4 - Presenter Information

Include the presenters that you have in mind for this session. Please note that you do not have to have all the presenters confirmed at the moment you submit this proposal.

First Name (Given) *

______

Last Name (Surname) *

______

Organization*

______

Title*

______

Country*

______

Email(s)*

______

Preferred language (if known)
English, Spanish, French, Arabic

______

Is additional funding NECESSARY?

Please only choose one from the options below.

_____No

_____Funding for flight

_____Funding for hotel

_____Both flight & hotel

Short Bio
If possible, include previous speaking engagements and links to videos of the presenter (YouTube video links).

Thank you for your submission!

Thank you for your interest in organizing a breakout session at the 18th Microcredit Summit. We hope to be in contact with you soon about your submission.
Please send this completed proposal to ith the subject "BREAKOUT SESSION PROPOSAL."

In the meantime, you can visit the Campaign website for more information:

[1]

Insert link to page

[2]

Insert the link of the guide here?