CLCO 2013 Workshop and presentation application form
1
A	
  Leader’s	
  Legacy:	
  Making	
  history	
  every	
  day	
  
2...
CLCO 2013 Workshop and presentation application form
2
Co-­‐presenter	
  2	
  –	
  Name:	
  
Title:	
  
Institution/Organi...
CLCO 2013 Workshop and presentation application form
3
A	
  Leader’s	
  Legacy:	
  Making	
  history	
  every	
  day	
  
	...
CLCO 2013 Workshop and presentation application form
4
Conference	
  Theme	
  
Please	
  describe	
  how	
  your	
  worksh...
CLCO 2013 Workshop and presentation application form
5
Please	
  indicate	
  your	
  A/V	
  needs	
  below.	
  This	
  inc...
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Columbus State Student Leadership Conference 2013 workshop and presentation application

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Columbus State Community College Student Leadership Conference Nov 8-9, 2013

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Columbus State Student Leadership Conference 2013 workshop and presentation application

  1. 1. CLCO 2013 Workshop and presentation application form 1 A  Leader’s  Legacy:  Making  history  every  day   2013  Collegiate  Leadership  Conference  of  Ohio       Workshops  and  Presentation  Application     This  year,  Student  Engagement  and  Leadership  (SEaL)  will  commemorate  Columbus   State’s  50th  Anniversary  by  empowering  the  next  generation  of  college  students  to   develop  their  leadership  skills,  construct  a  professional  network,  and  make  a  difference   through  civic  and  community  engagement.  This  year’s  conference,  “A  Leader’s  Legacy:   Making  History  Every  Day”  will  engage  students  through  workshops  (including  a  special   track  for  “First  Generation”  college  students),  keynote  speakers  and  community  service   projects.  The  conference  will  encourage  college  students  to  make  history  every  day  by   investing  themselves  in  the  world  around  them  and  by  actively  participating  in  their  own   leadership  evolution.     Application  Deadline:  September  27,  2013     Presenter  Information   Workshop  Title:       Co-­‐presenter(s)  if  Applicable   Co-­‐presenter  1  –  Name:   Title:   Institution/Organization  Name:     Email:   (All  communication  from  the  Planning  Committee  will  go  to  this  address.)     Address:   State:   Phone:   City:   Zip:   Fax:   City:     Co-­‐Presenter  1  Bio   Please  provide  us  with  a  short  bio  with  which  this  presenter  would  like  workshop  hosts  to   introduce  her  or  him:            
  2. 2. CLCO 2013 Workshop and presentation application form 2 Co-­‐presenter  2  –  Name:   Title:   Institution/Organization  Name:   Email:   (All  communication  from  the  Planning  Committee  will  go  to  this  address.)     Address:   State:   Phone:   City:   Zip:   Fax:           Co-­‐Presenter  2  Bio   Please  provide  us  with  a  short  bio  with  which  this  presenter  would  like  workshop  hosts  to   introduce  her  or  him:           Co-­‐presenter  3  –  Name:   Title:   Institution/Organization  Name:       Email:   (All  communication  from  the  Planning  Committee  will  go  to  this  address.)   Address:   State:   Phone:   City:   Zip:   Fax:           Co-­‐Presenter  3  Bio   Please  provide  us  with  a  short  bio  with  which  this  presenter  would  like  workshop  hosts  to   introduce  her  or  him:            
  3. 3. CLCO 2013 Workshop and presentation application form 3 A  Leader’s  Legacy:  Making  history  every  day     Workshop  Information   Workshop  Title:     Presenters:     Abstract  -­‐-­‐  REQUIRED   Please  provide  a  50-­‐word  abstract  of  your  workshop  to  be  used  in  conference  materials   (CLCO  reserves  the  right  to  edit  as  needed):               Workshop  Goals  and  Learning  Outcomes   Please  provide  an  outline  of  your  workshop's  goals  and  learning  objectives.               Workshop  Outline   Please  describe  how  your  workshop  will  achieve  the  above  stated  goals  and  how   participants  will  be  actively  engaged.             Workshop  Focus   Please  indicate  which  focus  best  describes  your  workshop.      Leadership  Skills    Constructing  a  Professional  Network    Making  a  Difference  through  Civic  and  Community  Engagement    The  Evolution  of  a  Leader    First  Generation  College  Students:  Blazing  a  New  Trail        
  4. 4. CLCO 2013 Workshop and presentation application form 4 Conference  Theme   Please  describe  how  your  workshop  relates  to  the  CLCO  2013  theme  –A  Leader’s  Legacy:   Making  history  every  day           Other:  If  your  presentation  or  workshop  does  not  fall  into  any  of  the  above  categories,   please  include  a  brief  description  of  your  focus  below.         Length  and  Time  of  Workshop   Workshop  Length   Single  Session  (50  minutes)   Double  Session  (110  minutes)  (only  offered  on  Saturday)     Preferred  Time   Please  indicate  your  preferred  time  to  present.  Please  note  that  preferences  will  be  given   based  on  date  of  proposal  submission.      Friday  evening    Saturday  morning    Saturday  Afternoon     Are  you  willing  to  deliver  this  workshop  more  than  once?    Yes      No       Audience  Preferences   Target  Audience   Please  check  all  that  apply.    Advisors    Emerging  Leaders    First  Generation  College   Students    Programming  Boards    Fraternity/Sorority  Members    Student  Government  Members    Residence  Hall  Students    Community  Members    Other  (Please  specify)     Audience  Size   We  know  that  some  workshops  are  geared  to  a  larger  audience  and  others  require  a   smaller  group.  To  facilitate  room  assignments,  please  indicate  your  intended  audience   size.  Please  check  all  that  apply.    10-­‐20    20-­‐30    30-­‐40    40-­‐50 Audio  Visual  Equipment   A/V  Requests  
  5. 5. CLCO 2013 Workshop and presentation application form 5 Please  indicate  your  A/V  needs  below.  This  includes  electronic  needs  as  well  as  hard   materials  such  as  flip  charts  and  markers.       NOTE:  All  rooms  are  equipped  with  PCs  and  projectors.  If  you  plan  to  use  your  own   laptop  or  a  flash  drive,  please  indicate  below  and  please  allow  time  to  set  up  before  your   presentation.  (Mac  users,  please  provide  your  own  adaptors).       Agreement   NOTE:  Each  presenter  must  sign  the  following:     Photo  Release  -­‐-­‐  REQUIRED   All  presenters  are  asked  to  agree  to  the  following:  I  hereby  give  the  Student  Ambassador   Leadership  Program  the  absolute  right  and  permission  to  copyright,  publish  or  use   photographs  of  media  which  may  be  included  in  whole  or  in  part  or  composite  or   distorted  in  character  or  form,  in  conjunction  with  my  own  or  fictitious  name,  or   reproductions  thereof  in  color  or  otherwise,  made  through  any  media  that  SALP  chooses   or  hires  someone  to  create  and/or  reproduce,  for  art,  advertising,  use  on  SALP  or   Columbus  State    website,  in  publications,  trade  or  any  other  lawful  purpose  whatsoever.     I  hereby  waive  my  right  to  inspect,  and/or  approve  the  finished  product  of  the   advertising  copy  that  may  be  used  in  connection  therewith,  or  the  use  to  which  it  may  be   applied.    I  have  likewise  communicated  this  photo  release  information  to  all  of  my  co-­‐ presenters,  if  applicable,  and  attest  that  they  have  also  agreed  to  its  terms.  I  am  18   years  of  age  or  older  and  I  am  competent  to  contract  in  my  own  name.  I  have  read  this   release  before  signing  below  and  I  fully  understand  the  contents,  meaning  and  impact  of   this  release.       NOTE:  Anyone  under  the  age  of  18  must  have  a  parent  or  guardian  sign  this  form,  and   indicate  below:   I  give  my  child  permission  to  participate  and  agree  to  the  terms  listed  above.    Yes/No     Electronic  Signature  -­‐-­‐  Please  Type  Full  Name   By  typing  or  signing  your  name  below,  you  acknowledge  that  you  have  read  and   understood  the  photo  release  above,  that  if  selected  you  will  present  this  workshop  at   the  Columbus  State  Leadership  Conference,  that  all  presenters  and  co-­‐presenters  must   register  for  the  conference  by  October  (CSCC  faculty  and  staff  exempt),  that  you   understand  that  Columbus  State  does  not  provide  stipends,  honoraria,  or  travel  expenses   to  presenters,  and  that  all  co-­‐presenters  (if  applicable)  have  seen  and  agreed  to  these   terms.     Name:     Date:   Please  type  in  the  date  of  submission  and  electronic  signature.  

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