Workshop Proposal Submission - IV-E Roundtable

FORM INFORMATION

Presentation Title*

Presentation Mode of Delivery*

Panel

Interactive Discussion

Single Presenter

Other

Panel/Other (if chosen)If panel chosen, Please specifiy how many panelists

Summary of Presentation*Describe the content of the workshop and how its relevant to Title IV-E supported education, training & or partnerships. Please describe any handouts, or audio visuals that might be used.

Program Description*Engaging 75-word program description to appear in Roundtable program

Goals and Objectives of Presentation*

Does your workshop require a special room setup?*

YES

NO

If yes please specifiy (below) what special room setup you require and we will do our best to accommodate the request

If yes

Does the proposed workshop require audiovisual support?*

YES

NO

(E.g. laptop, projector, microphone, web access, speakers etc.

if yes:

PRESENTER INFORMATION

Name of Lead Presenter*(list the name, degree, title, organizational affiliation you want printed in the program

Contact Phone Number*xxx-xxx-xxxx

E-mail Address*

Biographical Statement*Please include any other information you think will be helpful for the planning committee

Additional Presenter 1list the name, degree, title, organizational affiliation you want printed in the program

Biographical Statement 1Please include any other information you think will be helpful for the planning committee

Additional Presenter 2list the name, degree, title, organizational affiliation you want printed in the program

Biographical Statement 2Please include any other information you think will be helpful for the planning committee

Résumé: If your proposal is selected, we will ask you to forward an electronic version of your résumé.

If you encounter any difficulties completing this form, please e-mail titleive2019@stockton.edu for assistance.