ࡱ> KMJe \%bjbj 4Fxj\xj\""rrrL<&uuu%%%%%%%$'q*%ruS"uuu%""E%u""8r%u%:P,Z{̦| %%0&. +% + +ruuuuuuu%%,uuu&uuuu +uuuuuuuuu> : IAHPERD Program Proposal Form Provide the following information to propose a program you would like to present at the 2019 IAHPERD State Convention. All proposals must be received no later than June 1, 2019. Fill out the form completely! Type or Print Clearly. 1. Title of Proposed Program (should be descriptive of the program content - 10 WORD LIMIT)_________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 2. Brief Description of Program (25 words or less)____________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ ___________________________________________________________________________________ Speaker Name ______________________________________________________________________________ Illinois Educator Information Number (IEIN) _______________________________________________________ Work Name and Address ____________________________________________________________________ _________________________________________________________________________________________ Home Address _____________________________________________________________________________ _________________________________________________________________________________________ Telephone Number(s) Work__________________________ Home__________________________________ Fax ________________________________E-mail ________________________________________________ (LIST ADDITIONAL SPEAKERS ON THE BACK: ADDRESSES/PHONE/FAX/E-mail) Qualifications To be eligible to present a session for HOURS credit, a presenter must have at least 2 of the following for qualifications and / or experiences: Check all that apply _____ Have conducted research in the area of instructional delivery and methodology _____ Have completed coursework on effective teaching _____ Have past experience conducting workshops/sessions _____ Have published articles/books/newsletters _____ Have planned and prepared lessons using effective teaching strategies and practices _____ Have been the recipient of an outstanding teaching award State Learning Standards - Select all Applicable _____ STATE GOAL 19: Acquire movement and motor skills and understand concepts necessary to _____ STATE GOAL 20: Achieve and maintain a health-enhancing level of physical fitness based upon continual self-assessment _____ STATE GOAL 21: Develop skills necessary to become a successful member of a team by working with others during physical activity _____ STATE GOAL 22: Understand principles of health promotion and the prevention and treatment of illness and injury _____ STATE GOAL 23: Understand human body systems and factors that influence growth and development _____ STATE GOAL 24: Promote and enhance health and well-being through the use of effective communication and decision-making skills Explain how your session aligns to the Standards chosen: ____________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Purpose of the Session - Select all Applicable _____ Increase the knowledge and skills of school and district leaders who guide continuous professional development _____ Improve the learning of students _____ Organize adults into learning communities whose goals are aligned with those of the school and district _____ Deepen educator's content knowledge _____ Provide educators with research-based instructional strategies to assist students in meeting rigorous academic standards _____ Prepare educators to appropriately use various types of classroom assessments _____ Use learning strategies appropriate to the intended goals _____ Provide educators with the knowledge and skills to collaborate _____ Prepare educators to apply research to decision-making Professional Learning Standards - Select all Applicable _____ Learning Communities - Professional learning that increases educator effectiveness and results for all students occurs within learning communities committed to continuous improvement, collective responsibility, and goal alignment. _____ Resources - Professional learning that increases educator effectiveness and results for all students requires prioritizing, monitoring and coordinating resources for educator learning. _____ Learning Designs - Professional learning that increases educator effectiveness and results for all students integrates theories, research and models of human learning to achieve its intended outcomes. _____ Outcomes - Professional learning that increases educator effectiveness and results for all students aligns its outcomes with educator performance and student curriculum standards _____ Leadership - Professional learning that increases educator effectiveness and results for all students requires skillful leaders who develop capacity, advocate and create support systems for professional learning. _____ Data - Professional learning that increases educator effectiveness and results for all students uses a variety of sources and types of student, educator, and system data to plan, assess, and evaluate professional learning. _____ Implementation - Professional learning that increases educator effectiveness and results for all students applies research on change and sustains support for implementation of professional learning for long term change. 8. CIRCLE THE ONE CATEGORY AREA for which the presentation would be most appropriate: Physical Education Dance Adapted Health/Wellness Sports/Athletics Adventure Challenge Education Future Professionals 9. GRADE LEVEL SPECIFIC CIRCLE THE ONE AGE LEVEL THAT APPLIES TO YOUR PROGRAM: Do not circle them all or it will IAHPERD's choice Pre-5 6-8 9-12 College Other (e.g.) Adult 10. Length of Session: l hour 11. DAY AND TIME WILL BE ASSIGNED BY THE PROGRAM CHAIRPERSON 12. Space Requirements CIRCLE THE ONE TYPE OF ROOM AND DESIGN YOU WILL NEED: Theatre seating Large open area (gym/ballroom) Pool Dance Floor Special set-up/requirements/accommodations for mobility impaired 13. Are you an Exhibitor? Yes ______ No _____ If yes, have you completed an Exhibitor contract? Yes _______ No _________ Signature of Person Submitting Proposal: ___________________________________________________________________ Date: ______________________________________________________________ Send proposals directly to: IAHPERD Executive Director Kim Wheeler P. O. Box 865 Alton, IL 62002 FAX: (618) 4331764 E-Mail: iahperd@gmail.com owz|    Q a b m Z ȾިpbTTTh!' CJOJQJ^JaJh- XCJOJQJ^JaJ#h . h . 5CJOJQJ^JaJ h . h . CJOJQJ^JaJh . CJOJQJ^JaJ hhhQFjh5 h5>* h5>*hQFjh5>* hFT5>* hQFjhhg:h hQFjhhQFjCJ aJ h:JJCJ aJ hhCJ aJ   t H I   X Y hh^h`hgdQFj & F hd,^`gdQFj 0^`0gd . 0^`0gdC ^gd . gd . $a$gdC $a$gd G J   " V W X Y ` f    g t v w x y ,-.zᷦŕŕsŕŕŕŕŕŕ hhQFjCJOJQJ^JaJ hb1hQFjCJOJQJ^JaJ h . hQFjCJOJQJ^JaJ h . h!' CJOJQJ^JaJh . CJOJQJ^JaJhQFjCJOJQJ^JaJh!' CJOJQJ^JaJ h . h . 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