2017 GCSN Conference for STEM Education Presenter Application
SATURDAY, NOVEMBER 4, 2017
8:00 a.m. to 4:30 p.m.
Oxnard Community College

Sponsored by Gold Coast Science Network. Co-sponsored by California Science Teachers Association, Ventura County Office of Education and Oxnard College.

Sessions should focus on STEM content (science, engineering, technology, and math), instructional strategies, and/or resources; but workshops must support the Next Generation Science Standards (NGSS) and Common Core State Standards.

One complimentary conference registration will be given to the lead presenter of each workshop, including continental breakfast and lunch. Please submit a participant registration form with payment for any co-presenters.

Audience: Between 100 and 200 people interested in STEM education, primarily K-12 science educators from Ventura, Santa Barbara, Los Angeles, and Kern counties.

Please contact Kristin Majda at kmajda@yahoo.com or 805-444-6214 for more information or if you need help with this form. Alternatively, you may download the presenter application from our website at http://www.goldcoastscience.org and mail it via the postal service. However, ALL APPLICATIONS MUST BE RECEIVED BY SEPTEMBER 15, 2017; though earlier is much appreciated!

All applicants will be contacted by September 30, 2017 to inform them of whether or not their workshop has been accepted. If your workshop is accepted, please plan a 55 minute presentation.

Presenters are responsible for furnishing their own handouts and workshop materials. No copy service will be available onsite during the conference.

Thank you for your participation. The work you do is important and the conference would not be possible without generous and dedicated individuals like yourself. Together we can make STEM Education stronger, better, and more engaging for our youth!

APPLICATION
Name of Lead Presenter:
Your answer
Job Title:
Your answer
School or Organization:
Your answer
School or Organization Address (street, city, state and zip):
Your answer
Presenter Home Address:
Your answer
Presenter Phone:
Your answer
E-Mail Address (all conference updates and reminders are sent via email):
Your answer
Name of Co-Presenter:
Complementary registration for one presenter only. Please submit a separate participant registration form with full payment for any additional presenters.
Your answer
Co-Presenter E-Mail Address (all conference updates and reminders are sent via email):
Your answer
Co-Presenter Phone:
Your answer
Co-Presenter Job Title:
Your answer
Co-Presenter School or Organization:
Your answer
Co-Presenter School or Organization Address (street, city, state and zip):
Your answer
Co-Presenter Home Address:
Your answer
All workshops are 55 minutes. Do you prefer a morning or afternoon session?
Note: We will do our best to accommodate you but cannot guarantee your desired session time.
Title of Workshop:
Please limit to 40 characters including spaces and punctuation
Your answer
Description of Workshop for Program:
Maximum 25 words ~ make it catchy; this is how participants choose what to attend
Your answer
Grade Level (select all that apply):
Required
How does your workshop directly or indirectly support the Common Core and/or Next Generation Science Standards?
Please be specific and include the titles of standards if possible. Please contact kmajda@yahoo.com if you need help.
Your answer
Area of Emphasis (check all that apply):
Required
Type of Workshop:
Required
Equipment Required (select all that apply):
Any Additional Comments / Needs:
Your answer
SAFETY: The use of hazardous materials is to be avoided. Are there any potential safety hazards associated with your workshop?
Required
If you selected "Yes" above, please explain further and identify the precautions that will be taken:
Your answer
I agree to indemnify and hold harmless GCSN for any and all claims, loss, damage, or injury associated with unsafe practices related to my workshop.
Required
I agree to assume full financial responsibility for costs incurred as a result of unsafe practices related to my workshop.
Required
I agree not to sell items or collect money for any reason during my workshop.
Required
I understand that GCSN reserves the right to edit all titles and descriptions of workshops for the program.
Required
I am the person whose name is listed at the top of this application. By checking the "Yes" box below, I agree that it will serve as my signature.
Required
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