Tri-County Institute Presentation Proposal Form ---- February 14, 2020 ---- Centralia High School, Centralia, IL
Please submit a separate form for each new topic; If you have any questions please contact LaVonda Nichols at Kaskaskia Special Education: lnichols@ksed801.com or (618)532-4721; Proposals should be submitted by November 30, 2019.
Email address *
Presenter Information
If multiple presenters will be presenting this session, please list the lead presenter name in the "Presenter 1" fields below, and list any remaining presenters' names in the "Additional Presenters" field.
Packets containing conference details such as room and session assignments will be mailed or distributed by the end of January/early February to the lead presenter, and he/she will need to share the information with other presenters in the group.
Presenter 1: Last Name *
Your answer
Presenter 1: First Name *
Your answer
Additional Presenters
Please list any additional presenters
Your answer
School/Organization
Your answer
Work Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Phone
Your answer
Fax
Your answer
Presentation Information
**Please submit this form again for any additional topics** We are only able to accept 1 topic per form submission.
Presentation Title *
Your answer
Grade Level for which the presentation is appropriate *
You may list a range or individual level.
Your answer
Description of the Session
Please list a brief description. This will be used for the Program/Booklet for the conference.
Your answer
Handouts
If handouts will be presented with your session, please submit them to LaVonda by fax or email no later than January 31, 2020. Handouts are made available to participants electronically via the ROE website.

**Permission to post handouts to the site is assumed upon submission.**
Session Options - Single or Double Sessions
Please note:
New for 2020 - 5 Sessions will now be offered instead of 6

The conference is set up to allow for 5 sessions for the day. Single sessions are 50 minutes in length. You may select the single session format or you may choose to present as a double session. Double sessions are 100 minutes in length, and you may present up to 2 double sessions for the day.

-- Please select to present as either Single or Double sessions. Please do not select both single and double presentations for the same topic.
Please indicate how many single sessions you will present
Please indicate how many double sessions you will present
Accommodations
Accommodations Needed for Presentation - Please check all that apply
Power Point Version
If you will be using a Power Point Presentation, please let us know which version will be used
Your answer
Other notes or comments
Your answer
A copy of your responses will be emailed to the address you provided.
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