2018 PSAHPERD Convention Session Proposal
November 8-11, 2018
Seven Springs Mountain Resort

Session Proposal Form due by Friday, March 16, 2018

Please allow yourself time to complete this form. You will not be able to retrieve this information after it is submitted. If you have any questions, contact Judy Conroy, program chair at conroycape@gmail.com
Session Title *
Your answer
Description for Program & Brochure *
25 words or less
Your answer
Speaker Information *
One paragraph biography of speaker(s) including summary of qualifications.
Your answer
PA Academic Standard Grade Band *
Please choose grade level band for the standards you are selecting and check all that apply. To view standards from PDE website, click the following link: https://goo.gl/Dg6Yx2
Required
PA State Academic Standards Addressed *
Please check all that apply. To view standards from PDE website, click the following link: https://goo.gl/Dg6Yx2
Captionless Image
Required
Please select the content area below that BEST describes the focus of your presentation. *
Speaker 1 Information
Please include the following information for each speaker.
Are you a current PSAHPERD Member? *
Name *
First & Last Name
Your answer
Title
e.g. M.Ed., Ed.D if you want it listed
Your answer
What best describes you? *
School / Agency *
Your answer
Mailing Address *
Street Address, City, State, Zip
Your answer
Phone *
(111) 555-1212
Your answer
Email *
Your answer
Is the contact information listed above for work or home? *
Have you presented at a PSAHPERD Convention/Event before? *
If you answered YES to the above question, please list up to 3 most recent presentations with PSAHPERD. If you answered NO, please type "N/A."
Your answer
Have you ever received a Teacher of the Year Award?
Check all that apply. If no, skip this question.
If you answered yes to the above question, what year did you receive this award?
Your answer
Speaker 2 Information
Are you a current PSAHPERD Member?
Name & Title
e.g. M.Ed., Ed., etc.
Your answer
School / Agency
Your answer
Mailing Address
Street Address, City, State, Zip
Your answer
Phone
(111) 555-1212
Your answer
Email
Your answer
Is the contact information listed above for work or home?
Have you presented at a PSAHPERD Convention/Event before?
If you answered YES to the above question, please list up to 3 most recent presentations with PSAHPERD. If you answered NO, please type "N/A."
Your answer
Have you ever received a Teacher of the Year Award?
Check all that apply. If no, skip this question.
If you answered yes to the above question, what year did you receive this award?
Your answer
What best describes you?
Special Instructions for Participants *
Please indicate if participants in your session should bring any of the following items to maximize their participation at your session. CHECK ALL THAT APPLY.
Required
Any other special instruction for attendees?
Your answer
ONE DAY Workshop: Thursday, November 8, 2018
Complete this section ONLY if you plan to do a full or half day workshop on Thursday. Otherwise, select "I am NOT holding a workshop"
Length of Workshop *
If you are planning a half day workshop, please indicate whether you prefer AM or PM. While we cannot guarantee you preference, we will try our best to accommodate you.
Is there a cost for your workshop? *
If you selected yes to the above question, please explain.
Please note: PSAHPERD will only pay for sessions offering certifications, books or materials that participants receive. (Receipts must be submitted)
Your answer
Friday/Saturday 60 Minute Sessions
Preferred day/time *
Days & times cannot be guaranteed, but we will do our best to accommodate preference
Research Sessions Only *
What best describes the activity level involved in presentation *
Check all that apply
Required
Will you play music during presentation? *
Preferred arrangement *
Not guarenteed, but will try to accomodate
Audio-Visual Needs *
Projectors and screens will be provided in each room. If you need sound systems, mics, or anything else related to A/V, please make that request here. We will do our best to accommodate you.
Required
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