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STAR NET Region IV Planning Worksheet for Presenter’s Contract
This workshop is a WBR.
Yes
No
Is the STAR NET Region IV Resource Specialist taking care of your workshop arrangements.
*
Yes
No
Date completed (STAR NET Staff)
*
Yes
No
Date Revised ( STAR NET)
Yes
No
This workshop is in collaboration with:
*
If you have any questions, please contact them at:
*
Email
Workshop Date, and Time
*
Date
Time
Workshop Day(s)
*
Webinar
*
Yes
no
Webinar Day(s)
*
(Webinar: Note web link here)
*
Webinar Date, and Time
*
Date
Time
Workshop/Webinar Facilitator
*
Workshop/Webinar Title
*
Presenter’s Name
*
Workshop Location with Room #
Workshop Contact Name
*
Workshop Phone #
*
Workshop Room Fee
*
Cell Phone
*
Home Phone
*
Fax
*
Home Mailing Address
*
Address Line 1
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*
Emergency Contact
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Needs and cost
Presenter’s Fee
*
Presenter’s Fee
$ /Day X Day(s) =
*
$ /Day X Day(s) =
Presenter’s Fee Cost
*
Travel (50 cents/mile or airfare; car rental/limousine service)
*
Travel (50 cents/mile or airfare; car rental/limousine service)
miles round trip x .575 =
*
miles round trip x .575 =
Travel Cost
*
Hotel
tax
*
(add tax) $ (Recommended Rate for this area)
Hotel Cost
Per Diem (Our State Rate is $28.00/day)
Per Diem Cost
Other Needs
*
Yes
No
describe here
Total Contract Fees: Payment will be mailed approximately 45 days after the presentation.
Equipment you need STAR NET to provide:
*
Document Camera/ELMO
Laptop
DVD Player
Microphone
Easel/Flip Chart/Markers
LCD Projector
Screen
Speakers
Room Set up
Other
Intended Audience (Check all that apply):
*
Administrator
Early Childhood Special and General
Educators
Early Intervention Personnel
Family Member
Family Educator
Paraprofessional
OT/PT
Psychologist
SLP
Social Worker
Other By invitation only
Gateways Intended Audience (Check all that apply):
*
Center-Based
Home-Based
School-Age/Youth
Administrators
Parents/ Relatives
Trainers
Family Support Staff
Other
May we videotape this session?
Yes
No
Participants Limited to
*
Workshop Objectives
*
Workshop Description
*
Click here to enter text.
*
Time Ordered Agenda (Required by regulatory agencies to provide credentialing contact hours - please do not include breaks in this agenda):
Click here to enter text.
*
IELDS Rationale (Illinois Content Standards): Please include a sentence describing how you will address the Illinois Early Childhood Learning and Development Standards in your presentation. To review the IELDS, please visit:
Early Learning Standards
Content Level (Please choose one.)
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Introductory Level 1: – Remembering/Understanding
Intermediate Level 2: – Applying/Analyzing
Advanced Level 3: – Evaluating/Creating
We would like for your presentation to address the following Illinois Professional Teaching Standard: The teacher understands and uses a variety of instructional strategies to encourage student's development of critical thinking, problem-solving, and performance skills.
Brief Biography (Between 50-100 Words)
*
Click here to enter text.
*
If we want to purchase resources as door prizes, what books or other resources do you recommend that support your presentation?
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*
Handouts you want to be copied must be received at STAR NET, Attn: Dinnia Cooper, 1000 S. Illinois St., Belleville, IL, 62220, or
[email protected]
by If you have questions about your handout after it has been sent, contact Dinnia at
618-825-3968
.
Special Request(s):
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