Survey of Interest in Technology Workshop

1. Survey to Determine Interest in a Technology Related Worshop for Administrators and Key Leaders

 
There is an interest in hosting a workshop with either Alan November or members of his team. Alan is a world-wide speaker and leader in both technology and school leadership. You can view information about Alan November at http://www.novemberlearning.com Please complete this survey if your division has an interest in this workshop / topic. Completing the survey DOES NOT obligate you to participation. A memorandum of understanding will be developed if sufficient interest is found across the region.
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1. Name of the School Division
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2. Contact person for the workshop
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3. E-mail Address for the Contact Person
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4. Phone Number for the Contact Person
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5. Fax Number for the Contact Person
6. Workshop Preference
First ChoiceSecond ChoiceThird Choice
Full Day (including lunch)
Full Day (exclude lunch
½ Day
7. Timing of the Workshop
First ChoiceSecond Choice
Spring (During the regular work week)
Summer (After June 15th)
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8. Estimated Number of persons that Would Attend

9. Cost sharing method (Maximum Amount to be paid by division)
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10. Cost sharing method (Maximum Amount to be paid by division per person)
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11. Maximum Cost Per Division, if division charge is used instead of a per person cost
12. Other Comments
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