IAHPERD Exhibitor Program Proposal Form



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)_________________

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2. Brief Description of Program (25 words or less)____________________________________________________

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3. Speaker Name ______________________________________________________________________________

Illinois Educator Information Number (IEIN) _______________________________________________________

Work Name and Address ____________________________________________________________________

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Home Address _____________________________________________________________________________

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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

4. 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

5. Explain how your session aligns to the Standards chosen: ____________________________________________

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6. 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

7. 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: ______________________________________________________________

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Send proposals directly to:

IAHPERD Executive Director – Kim Wheeler

P. O. Box 865

Alton, IL 62002

FAX: (618) 433–1764

E-Mail: iahperd@

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