The Teacher Center of Broome County

Workshop Proposal Form 2014 - 2015

We are always looking for teachers to share their great ideas and skills with other teachers. If you would like to propose a workshop that you feel would be beneficial to other teachers please fill in the form below and submit it electronically. All proposals are reviewed by the TC program committee, and if your proposal aligns with the identified needs and goals for the current year you will be contacted.

First Name

Last Name

School District

School

Home Address

City

State

Zip Code

Telephone (Work)

Telephone (Home)

Telephone (Cell):

FAX

E-Mail Address

ggg

Co-Presenter's Name:

District:

School:

Home Address:

City

State

Zip Code

Telephone (Work):

Telephone (Home):

Telephone (Cell):

FAX:

E-mail Address:

ddd

Workshop Title

Site of Workshop: (Will you be presenting this workshop in the Teacher Center's classroom or at a school site?) Note: All workshops that require computers should be held at the Teacher Center location.

Workshop Length:

Level of Workshop:

Basic

Intermediate

Advanced

Aligning workshops to the Common Core State Standards and to the 21st Century Learning Skills is important for our work at the Teacher Center of Broome County. Please identify the CCSS and/or the 21st Century Learning Skills that you will address in your workshop using the space below.

Common Core State Standards Link

21st Century Learning Skills

List below the Common Core Learning Standards and/or the 21st Century Learning Skills that this workshop will address.

Workshop Outcomes:

Workshop Description (this will be used to advertise your workshop):

Who is your target audience? Please be sure to include the Grade level as part of your target audience. (Specific type of background knowledge and/or experience desirable)

Possible Dates/Times for your Workshop: (The Teacher Center generally has after school hours for workshops 4:00-6:00 pm)

Have you presented this type of workshop before?

Yes

No

Equipment Needs: Please check off any equipment that you will need. Handouts are the presenter's responsibility. The Teacher Center can make limited copies for you free of charge as long as we receive them at least one week prior to the workshop date.

Please list two references below who are familiar with your presentation style. Please provide name, address, phone, e-mail for each reference.

References:

Thank you for submitting a Workshop Proposal. We will acknowledge the receipt of your information via e-mail. If your workshop is selected by the program committee you will be contacted so that a date and time for the presentation can be arranged.

Laptop Computer	Smart Board	Computer Lab
iPads	Chart Paper	DVD Player
Multimedia Projector	Document Camera	Overhead Projector
Screen	Other Other