OCSEA Fall Conference
Workshop Presenter's Form

All fields with a star (*) are required. The form will not be completed until all the required fields are correctly filled in.
Personal Information
Date:
ex. (5/13/04)
Salutation (Mr., Mrs., Ms., Dr.):
First Name *:
Middle Initial:
Last Name *:
Title:
Organization:
Address :
City :
State :
Zip :
Phone (work):
Phone (home) [not to be released] *:
Email Address *:
Workshop Information
Please Check One of the Boxes Below to Describe the General Area of Your Workshop
Elementary (K-3):
Elementary (4-5):
Middle (6-8):
Pedagogy (K-8):
Technology (K-8):
Other (Please describe):

 
Workshop Title:
Target Grade Level(s) (K-8):
Brief Abstract (1-2 sentences):
CA Science Standards Addressed in the Workshop (if applicable):
A/V Requirements
LCD Projector Yes No
TV/ VCR Yes No
Viewgraph Projector Yes No
Facilities Required for Workshop
Classroom Yes No
Laboratory Yes No
Tables / Benches Yes No
Other (describe)
Utilities Required / Other
Water Yes No
Electricty Yes No
Gas Yes No
Other (Please Describe)
Special Needs (Please Describe):
Need Help Unloading Vehicle Yes No
Handouts Provided Yes No
Student Assistance Needed Yes No
Please use the text box to the right to answer the following questions:

1. Is there any Workshop Time Slot during which you are NOT available:
8:40 a.m. - 9:55 a.m.: Workshop #1
10:05 a.m. - 11:20 a.m.: Workshop #2
1:00 p.m. - 2:15 p.m.: Workshop #3
2:25 p.m. - 3:40 p.m.: Workshop #4

2. Do you plan on attending the full conference or only coming to present your workshop?

3. Do you plan on enjoying the lunch which is included in your complimentary registration?