SI 2019 Ignite Session Proposal
Please submit this form if your school is interested in presenting during the Ignite 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 70% (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)

Number of Certified Staff in your building *
Your answer
Number of responses on the Self-Assessment Survey (SAS) *
Your answer
Schoolwide *
% In Place
Your answer
Non-classroom *
% In Place
Your answer
Classroom *
% In Place
Your answer
Ignite Session Information
All proposals will be reviewed by a statewide committee. Alignment with SW-PBS Essential Components is required. Any and all practices and interventions presented must be evidence based. Ignite Sessions are a new type of session intended to stimulate the exchange of new and exciting ideas in a short time period. Ignite Sessions will be scheduled for 1 hour and consist of up to six 5-minute talks presented in the Ignite style (http://igniteshow.com/) focusing on the following topics: Administration, Alternative Schools, Classroom Management, Early Childhood, High School, Student Engagement, Sustaining Tier 2, and Sustaining Tier 3 . Each Ignite talk will feature 20 slides that advance automatically every 15 seconds. There will not be time during the 5 minute presentations for questions, but there will be time after all schools have presented to network and ask questions in small groups. Be prepared to discuss outcome data that has had a positive impact on the social competence and/or academic achievement of students in your building. A pre-formatted powerpoint will be sent to your school if your proposal is accepted.
Proposed Session Theme: *
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 session materials prior to the Summer Training Institute, introduce the school presenters, provide the research base for the session topic, and then close the session.
Your answer
Title of Proposed Ignite Session (this title will be printed in the program).
Your answer
Provide a brief (75-100 word/1-2 sentences) description of the proposed session. *
Your answer
Describe the systems that your school has put into place to ensure that the accurate implementation of the practices outlined in the proposed session can and does occur. *
Your answer
Describe the data used to identify the status of current practice and evaluate the impact of the interventions or practices outlined in the proposed session. *
Your answer
Describe the practices in place to support students that are related to the topic of the proposed session. *
Your answer
Describe the outcome data that is available to support that the proposed session topic is having a positive impact on the social competence and/or academic achievement of students in your building.
Your answer
Ignite Presenter Name *
Your answer
Ignite Presenter Job Title *
Your answer
Ignite Presenter Email *
Your answer
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 registration fee will be waived for each Ignite proposal that is accepted. I understand that the conference organizers will provide a laptop, one screen, one microphone and one table in each room. I understand that I must submit my Ignite presentation by the deadline so it can be preloaded to the presentation laptop.
I understand and agree to the Statement of Intent *
Type initials here
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