Fall 2011 Kentucky Honors Roundtable Proposal Submission Form Survey

Please list the names of the presenters as they should be printed in the program.

Name of Presenter #1:

Please list the names of the presenters as they should be printed in the program. Name of Presenter #1:

Classification of Presenter #1:

E-mail Address of Presenter #1:

Name of Presenter #2:

Classification of Presenter #2:

E-mail Address of Presenter #2:

Name of Presenter #3:

Classification of Presenter #3:

E-mail Address of Presenter #3:

Name of Presenter #4:

Classification of Presenter #4:

E-mail Address of Presenter #4:

Name of Presenter #5:

Classification of Presenter #5:

E-mail Address of Presenter #5:

Name of Institution:

Honors Program/College Information

Honors Program/College Information Address:
Address 2:
City/Town:
State:
ZIP:

Title of Presentation:

Please select one of the following formats for your presentation:

Please select one of the following formats for your presentation: Podium Presentation (one speaker for 10-13 min and 5 min Q&A)

Poster Presentation (posters will last for 1-2 hours)

Short Panel (15 min and 10 min Q&A; must be more than 1 presenter)

Long Panel (40 min and 15 min Q&A; must be more than 1 presenter)

Short Digital Film (max 6 min)

Music or Dramatic or Dance Performance (max 6 min)

Art/Sculptor Exhibition (will be displayed for the day of the conference)

Select equipment needed. Check all that apply.

Select equipment needed. Check all that apply. TV/VCR

Computer/Projector

Other (please specify)

Name of Honors Program/College Director (submission of proposal indicates approval by director):

E-mail Address of Honors Program/College Director:

Abstract (maximum length 100 words):