SI 2019 Poster Session Proposal
Please submit this form if your school is interested in presenting a poster during the Poster Session.
Identifying Information
Person Submitting Proposal *
Your answer
Job Title *
Your answer
Email Address *
Your answer
School District *
Your answer
Building Name *
Your answer
Grade Levels Served: *
RPDC Region: *
MO SW-PBS Training Level: *
Please select the MO SW-PBS training level that your building is currently participating in.
2017-2018 MO SW-PBS Recognition Status: *
Fidelity of Implementation Criteria
2017-2018 and 2018-2019 MO SW-PBS data submission and implementation data will be reviewed to ensure that building is an active participant with MO SW-PBS and implementing SW-PBS with fidelity. This verification includes:

1. 2017-2018 Self-Assessment Survey (SAS) Schoolwide, Non-classroom and Classroom sub scale scores of at least 60% (please review your Total Score report at www.pbisapps.org)
2. Completion of 2018-2019 School Safety Survey (SSS)
3. Submission of 2018-2019 quarterly data (Quarter 1 and Quarter 2)

What Tier(s) will be the focus of your poster? *
Required
Indicate the name of the MO SW-PBS Consultant that will be your Session Collaborator. *
The Session Collaborator is a MO SW-PBS Personnel that will review poster materials prior to the Summer Training Institute.
Your answer
Proposed Poster Title (this title will be used in the conference brochure): *
Your answer
Provide a brief (50 word) description of what content your poster will cover. *
Your answer
Provide at least one poster outcome. (These outcomes will be included in the Poster Session handout) *
Begin your outcomes with "Attendees will." For example: Attendees will understand our school recognition system.
Your answer
Which of the 4 essential interactive elements will your poster highlight? (please choose AT LEAST one - bonus points will be given for choosing and describing at least two)
Describe HOW your poster will highlight the essential interactive element(s) you chose above.
Your answer
Poster Contact Name: *
Your answer
Poster Contact Position: *
Your answer
Poster Contact Email Address: *
Your answer
Will you need access to an electrical outlet for this poster? *
Statement of Intent
If this proposal is selected, I agree to take part in the program and register for the conference. I understand that only 1/2 of one registration fee will be waived for each proposal that is accepted. I also understand that the conference organizers will provide a table for each poster accepted. A picture of your presenters/posters may be used by MO SW-PBS for promotional purposes, at training, or on the website. Presenter bears the responsibility for preparing, setting up and manning the poster during the Poster Session.
I understand and agree to the Statement of Intent *
Type initials here
Your answer
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