Tri-County Presentation Proposal Form ---- February 15, 2019 ---- 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: or (618)532-4721; Proposals should be submitted by November 30, 2018.
Email address *
Presenter Information
If multiple presenters will be participating with this topic, please list 1 name in the "Presenter 1" fields below, and list any remaining names in the "Additional Presenters" field.
Last Name - Presenter 1 *
Your answer
First Name - Presenter 1 *
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
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 for the conference.
Your answer
Handouts are made available to participants electronically via the ROE website. Please submit handouts to LaVonda by fax or email no later than January 25, 2019.

**Permission to post handouts to the site is assumed upon submission.**

Session Options - Single or Double Sessions
The conference is set up to allow for 6 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 3 double sessions for the day.
Please indicate how many single sessions you will present
Please indicate how many double sessions you will present
Please select to present as either Single or Double sessions. Please do not select both single and double presentations for the same topic.
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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