Workshop Proposal Form for Board Approved MHTC Presenters 2018-19
This form is to be used by those who have been approved by the Mid-Hudson teacher Center Policy Board. If you have not yet been approved please use the "Workshop Proposal Form for those Seeking to be Approved MHTC Presenters"
Presenter/Facilitator's Name *
Your answer
Address *
Your answer
City, State and Zip Code *
Your answer
Telephone Number (cell/home or both) *
Your answer
Email Address *
Your answer
Audience *
example: teachers, special education teachers
Your answer
Grade Level *
Example: K-3, Pre K-6, High School
Your answer
Title and Description of the workshop, include specifics about what the participants will know and be able to do as a result of this learning experience. Also describe what participants will create during the workshop (a lesson plan, inventory of resources etc.) *
Your answer
Topic (Main Focus) *
Choose One or two
Standard (Main Focus) *
Choose One
Suggested Location(s) for workshop. Specify if it is to be conducted as synchronous (live) online, at a particular location, or a combination of both (hybrid). *
Your answer
Equipment needed for workshop. Specify for students and for instructor. *
Example: wireless internet, SmartBoard, Projector
Your answer
Maximum Number of Participants (we generally cap the online synchronous at 15 because we want them to be interactive and participatory) *
Your answer
Students and Learning -Please check the CCLS that will be covered at the workshop
There can be more than one CCLS
Content and Instructional Planning-Please check the CCLS that will be covered at the workshop
There can be more than one CCLS
Instructional Practice-Please check the CCLS that will be covered at the workshop
There can be more than one CCLS
Learning Environment-Please check the CCLS that will be covered at the workshop
There can be more than one CCLS
Professional Responsibilities and Collaboration-Please check the CCLS that will be covered at the workshop
There can be more than one CCLS
Professional Growth-Please check the CCLS that will be covered at the workshop
There can be more than one CCLS
Assessment for Student Learning-Please check the CCLS that will be covered at the workshop
There can be more than one CCLS
Total number of contact hours. *
Avaliable Dates for Workshop *
Your answer
Approximate time of workshop *
If at a location, then indicate when can you arrive at the location.
Your answer
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