*Required Fields

*Activity/Course Name:

*Course Description:   

*Funding Source:   

*Professional Development Points Available?   Yes    No   If "Yes," please complete PD-1 (Request Approval to Offer Professional Development Workshop).  Form is located at PD-1
 

*Date: January February March April May June July August September October November December/ 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31/ 2007 2008 2009    For multiple dates needed, please enter them in the box below entitled
                                   "Special requests regarding room arrangements"

*Stipends Available?  Yes    No

*Time:  From: 01 02 03 04 05 06 07 08 09 10 11 12: 00 15 30 45   AM   PM

*Time:       To: 01 02 03 04 05 06 07 08 09 10 11 12:  00 15 30 45  AM   PM

*Contact Name:

*Contact Phone Number: ()    E-Mail Address:

*Contact Address:        Fax: 

Instructors: 

*Estimated Number of Participants:  

*Requested Room Arrangement.  Please select one:

Audio/Visual Requests

Equipment
SmartBoard
Promethean Board
VCR
Overhead-Projector
CD/Audiotape Player
Visual Presenter (Elmo)
Microphone:  How many?
            Corded
            Wireless
                Lapel
                Handheld
     Video projector for a computer you are bringing:
    Select the type of computer you are bringing. Computer is a PC Computer is a Macintosh

   
Speakers
DVD Player

Internet Access

Particular software in computer lab?   Specify:

Will you be having food served?    Yes  No
Will you be having food catered?    Yes   No   

            Name of Caterer: 

Do you have a particular room request?

Should we put your event on the District/Professional Development Calendar?  Yes    No

Special requests regarding room arrangements: