Summer Institutes - Speakers' Bureau Submission Form
The information requested on this form is, in essence, the same as that requested for PD on Demand. That way, we are able to develop a more complete Speakers' Bureau with full information that will allow presenters, if they so choose, to participate in both opportunities. It is much easier to have this information readily available, rather than having to reach out to you when time may be of the essence. Additionally, since you would be speaking on behalf of AMTNJ, this application will serve, in part, as the process to insure that you have the expertise to represent AMTNJ well.

Summer Institutes require a minimum of six paid attendees. The speaker will receive $600 for presenting a full day workshop at AMTNJ's summer institute. Each speaker will be required to fill out a W-9 form prior to the first workshop for the year. Accepted speakers are required to speak at a math conference that an AMTNJ Teacher Outreach Committee Member or appointee can attend prior to being accepted to present at a summer institute. This is a one-time requirement. If you have done it before and a committee member has attended your workshop, then the committee will waive this requirement. At least one month prior, send Dianna Sopala (diannamsopala@yahoo.com) an email stating when and where you are speaking.

Presenters may not advertise or sell products during their sessions.

(Please note: Information may be copied and pasted into this document from other sources.)

Title
Please enter your preferred title - If other, please also complete the follow-up question.
First Name
Please enter your first name.
Your answer
Last Name
Please enter your last name.
Your answer
Street Address
Please enter your preferred street address for mailings.
Your answer
City
Please enter the town or city of your preferred address.
Your answer
State
Please choose your preferred state address.
Zip Code
Please enter the zip code for your preferred mailing address.
Your answer
Phone Number
Please enter your preferred contact phone number (including area code).
Your answer
Type of Phone Contact
Please select the type of phone contact.
Email Address
Please enter your preferred email address.
Your answer
Type of Email Contact
Please indicate the location of your email address.
Leading Affiliation
Please enter your current employment location or the organization with whom you are most closely associated.
Your answer
Additional Affiliation(s) (optional)
If you have any additional affiliation(s) that you want noted, please enter it (them) here.
Your answer
Foremost Experience Descriptor(s)
Please choose the job title(s) that best describe your most predominant experience(s).
Required
Professional Responsibilities
Please briefly describe the main responsibilities that describe your experiences. (Please limit to about 50 words.)
Your answer
Grade Bands/Audience
Please enter as many grade bands and/or groups to whom you are comfortable presenting.
Required
Areas of Expertise
Please check off as many broad areas of expertise with which you are comfortable presenting.
Required
Availability
Please indicate all of the times that you would be available to make presentations or workshops.
Required
Years of Experience in Education
Please indicate the number of years that you have been involved in education.
Years of Experience in Professional Presentations
Please indicate the number of years that you have been speaking or providing professional development
Multi-Day Workshops
Are you willing to consider doing multi-day workshops?
Follow-Up Sessions
If your group would like additional sessions, would you consider providing them?
First Reference
Please enter the name, address, phone number, email address, and affiliation of your first reference.
Your answer
Second Reference
Please enter the name, address, phone number, email address, and affiliation of your second reference.
Your answer
Third Reference
Please enter the name, address, phone number, email address, and affiliation of your third reference.
Your answer
Recent Presentations (1)
Please enter the title, location, date, audience, and a brief description (approximately 50 words) of a recent presentation (1).
Your answer
Recent Presentation (2)
Please enter the title, location, date, audience, and a brief description (approximately 50 words) of a recent presentation (2).
Your answer
Recent Presentation (3)
Please enter the title, date, location, audience, and a brief description (approximately 50 words) of a recent presentation (3).
Your answer
Would you be interested in speaking for AMTNJ for PD on Demand?
Please be aware that the rate of compensation is different (higher) for PD on Demand. Please review the information for speaking at PD on Demand.
Additional Information
Please provide any additional information that you believe would be helpful to have on record.
Your answer
Have you submitted a recent version of your resume to AMTNJ?
If not, please send a copy to diannamsopala@yahoo.com.
What is the title of your first workshop that you want to present for next summer? Please include a grade level or audience in your title.
(All applications must be submitted by October 1 to be considered for the following summer.)
Your answer
Please state a blurb for your first workshop. This blurb will be published in AMTNJ's Summer Institute flyer to encourage educators to come to your workshop.
If you want the participants to bring a laptop, calculator, or anything else, please state it in your blurb.
Your answer
Are there any dates you can not present next summer?
What dates are you unable to present your summer institute(s)?
State "none" if you can present any day next summer.
Your answer
Do you want to submit a second workshop to present?
What is the title of your second workshop that you want to present for next summer? Please include a grade level or audience in your title.
Your answer
Please state a blurb for your second workshop. This blurb will be published in AMTNJ's Summer Institute flyer to encourage educators to come to your workshop.
If you want the participants to bring a laptop, calculator, or anything else, please state it in your blurb.
Your answer
Do you want to submit a third workshop?
What is the title of your third workshop that you want to present for next summer? Please include a grade level or audience in your title.
Your answer
Please state a blurb for your third workshop. This blurb will be published in AMTNJ's Summer Institute flyer to encourage educators to come to your workshop.
If you want the participants to bring a laptop, calculator, or anything else, please state it in your blurb.
Your answer
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