California State University, Northridge, Center on Disabilities' 21st
Annual International Technology and Persons with Disabilities
Conference ~ March 20-25, 2006
Pre-Conference Days: Monday, March 20 & Tuesday, March 21, 2006

PRE-CONFERENCE WORKSHOP PROPOSAL

Please complete all sections and submit no later than Friday, September 30, 2005

PRESENTER(S) INFORMATION

(1) Name:*
Position/Title: *
Organization: *
Mailing Address: *
City: *
State/Province/Region: *
Zip/Postal Code: *
Country: *
Day Phone: *
Fax:
Email: *
(2) Name:*
Position/Title: *
Organization: *
Mailing Address: *
City:
State/Province/Region:
Zip/Postal Code:
Country:
Day Phone:
Fax:
Email:

* there are more than 2 presenters, please insert additional names and contact information.

Education Session Outline

Speaker Qualifications:
Please include a brief biography for each speaker along with their contact information in this section. Resumes cannot be accepted. Include information on current position and qualifications to present topics as listed. Biographies should not exceed one page per speaker.

Title: Please limit the title to 12 words or less.

Summary & Format: Please include the basic content of the proposed workshop and indicate if it is designed for a full or half-day.

Learning Objectives: Please state a minimum of 4 learning objectives.

Level of Workshop: Carefully choose one level that best describes the typical audience for your subject matter.

Beginner: Designed for those who are just entering the field of assistive technology and have little or no experience in this field.
Intermediate: Designed for those who have been working in the field of AT for 5 yrs+ and have a general understanding and knowledge of AT.
Advanced: Designed for those who are considered very knowledgeable in the topic area covered.

Major Disability Group: Please check all that apply to your workshop.
Behavioral/Emotional Disorders
Deaf/Blind
Deaf and Hard of Hearing
Developmentally Disabled
Learning Disabled
Mobility/Physical/Orthopedic
Speech/Language
Traumatic Brain Injury
Visual Disability
All

Handouts:
Please list the types/categories of information you will distribute in handout format.

Equipment Requirements:
Please check equipment you are requesting for your presentation. If equipment is not listed, it is the responsibility of the presenter to acquire. Please note all session rooms are equipped with a projection screen, a color projection unit, one lavaliere microphone, and one hand held microphone.
Windows based PC
Apple based PC
Internet Access
VCR (NTSC Format)
Easel, Pad, & Markers
Other: (Type selections in space below)

*Other equipment subject to availability. You will be notified by the Center if the equipment you are requesting is not available.

Desired Room Set-Up:
Classroom
Rounds of 8
PC Computer Lab
MAC Computer Lab
Other: (please describe)

Please return completed form no later than Friday, September 30, 2005 to:

Charlene L. Meeks, Conferences Coordinator
California State University, Northridge, Center on Disabilities
18111 Nordhoff Street
Northridge, CA 91330-8340
Phone: 818/677-2578
Fax: 818/677-4929
Email: charlene.meeks@csun.edu