2010 IN ED Conference Proposal Form

2010 Indiana Annual Conference on Emotional Disabilities
Instructional & Behavioral Practices for Students with Challenging Behaviors

Presentation Proposal Form

DEADLINE FOR SUBMISSIONS: March 1, 2010

NOTIFICATION OF ACCEPTANCE: March 15, 2010

Please Note:

Multiple proposals are invited, however, please submit one online form per proposal.

All presenters and co-presenters must register for the conference. Due to budgetary considerations, it is not possible to offer either an honorarium or a waiver of registration fees to program presenters. Your proposal is an acknowledgement of this requirement.

The principal presenter is responsible for keeping all co-presenters informed of all correspondence from BICA and the conference planning committee.

Presenters are solely responsible for the information presented. Acceptance of a proposal does not imply that the content represents an official position, endorsement or support by BICA, its employees or Board of Directors.

Please type your initials to electronically indicate that you have read and agree to the above-noted requirements:

Please provide the following PRINCIPAL PRESENTER contact information:

First Name

Last Name

Middle Initial

Organization

Address Type Home Work

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Work Phone

(format xxx-xxx-xxxx)

Home Phone

(format xxx-xxx-xxxx)

FAX
(format xxx-xxx-xxxx)

E-mail

Confirm E-mail:

CO-PRESENTER 1 contact information (if applicable):

First Name

Last Name

Middle Initial

Organization

Address Type Home Work

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Work Phone

(format xxx-xxx-xxxx)

Home Phone

(format xxx-xxx-xxxx)

FAX
(format xxx-xxx-xxxx)

E-mail

CO-PRESENTER 2 contact information (if applicable):

First Name

Last Name

Middle Initial

Organization

Address Type Home Work

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Work Phone

(format xxx-xxx-xxxx)

Home Phone

(format xxx-xxx-xxxx)

FAX
(format xxx-xxx-xxxx)

E-mail

ADDITIONAL C0-PRESENTERS:

If you have more than three presenters, please use this space to type in their names and addresses (if addresses are the same as other presenters, you may just indicate so).

PREFERRED PRESENTATION TYPE:

	Workshop (120 minutes)
	Breakout Session (60 minutes)
	Poster Session

Please indicate if there are any times you are UNABLE to present:

Thursday

Friday

Please use this space to make any notes regarding your presentation preferences and availability:

PRESENTATION TITLE:

BRIEF DESCRIPTION FOR PROGRAM:

Please provide a brief (approximately 60-word) description for the conference program. In your description, please indicate your intended audience (i.e., early childhood, elementary, middle school, secondary, higher ed, all) and level of the material you will present (i.e., introductory, intermediate, advanced, all levels).

TOPIC:

Please select the ONE that best fits

Academic Instruction

Assessment for Intervention/RTI

Autism Spectrum

Curriculum-Based Behavioral Intervention

Effective Classroom Management

General Education/Special Education Collaboration

Home-School Partnerships

Mental Health Issues & Services

Positive Behavior Intervention Support

Program/School Improvement

Services in Residential/Secure Settings

Other: Please specify:

LEARNING OUTCOMES:

Please provide a bulleted list of what participants will learn from this session.

Note: certain CEU providers require specific learning objectives.

PROPOSAL:

What is the purpose of the presentation (why is this important and who is the target audience)? What are you planning to do? What are the practical applications (how can your results/strategies be used by others)? How does this presentation address research-based standards? Please type or cut and paste (up to 500 words)

EQUIPMENT NEEDS:

Notes:

A screen will be set up in each presentation room and rooms will be set theater-style.

You are welcome to bring your own equipment, however BICA will not be responsible for any personal equipment used for presentations.

BICA cannot provide laptop computers.

Please check all that apply.

Overhead Projector

LCD Projector (DVDs should be run off computers through LCD Projectors)

Flip Chart

Other:

SPECIAL NEEDS: Please indicate if you have any special needs or requests.

THANK YOU!