We are in the process of planning the SchoolCIO Summits for 2017. These intimate, invitation-only events are geared to district- and state-level education leaders with a strong interest in technology's role in schools. Please use this form to indicate your interest in attending one of these Summits. Space is extremely limited and we can not guarantee you a spot but we promise to let you know as soon as possible whether you have been accepted.

* 1. Please fill out your contact information:

* 2. If you have an assistant you would like us to cc on future correspondence, please fill out this information:

* 3. Please indicate which of the following 2017 summits you would be interested in attending:

* 4. How did you learn about these events?

* 5. Have you attended a previous SchoolCIO Summit?

* 6. Membership in SchoolCIO is required for attendance at a SchoolCIO Summit (which, other than that, is free to those who are invited). Please indicate which of the following applies to you:

* 7. Please describe, briefly, the technology-supported initiatives/approaches that you are most excited about sharing with other district leaders at this event.

* 8. Please comment on any topics that you think are MUST-includes in the 2017 summits.

* 9. Please indicate which of the following computers/devices are being used primarily in your district for instruction:

* 10. Please indicate the number of students served by your district

* 11. Are you interested in inviting another member of your team (superintendent, associate sup't, CIO/CTO, etc.)?

* 12. If so, please indicate:

* 13. This person:

* 14. If you'd be interested in serving on the planning team for a 2017 summit (helping to recruit amazing attendees and speakers, moderate sessions, etc.) please elaborate on the role you'd like to play.

* 15. Do you have a close working relationship with a company that would make a good Summit sponsor? If so, please explain.

* 16. Please indicate any additional people (from a district other than your own) you would recommend as speakers or  participants in the SchoolCIO summit.

* 17. Additional Comments:

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