Common Threads 2017 - Youth Workshop Submission Form

CANDLE’s Youth Pride Initiative is excited to announce the 19th Annual Common Threads Youth Empowerment Retreat. Approximately 100 youth will gather on January 13th-15th, 2017 in Stony Point, NY. We are currently seeking presenters for 16 youth workshops for Saturday, January 14th, 2017. Workshops consist of approximately 25 participants and last for 1 hour and 15 minutes. If you are interested, please fill out the following survey completely.

Preference will be given to workshops that incorporate multiple priority areas and/or demonstrate the LGBTQ cultural competence of the presenter(s).

Workshop Submission Forms are due by October 31, 2016. Presenters of accepted workshops will be notified via email by November 16, 2016.

Question Title

* 1. Please check the topics that your workshop covers:

Developing positive regard towards all differences, especially sexual orientation and gender identity.

Increase knowledge about oppression, especially related to heterosexism, homophobia, biphobia, transphobia and in-group discrimination.

Artistic self-expression (e.g., writing, dance, drawing/painting).

Increase knowledge about gender identity or transgender issues

Advocacy skills and related communication skills.

Opportunity practice activities designed to relieve stress

LGBT health/sexual health

Interpersonal relationships and related communication skills

LGBTQ cultural competence

Question Title

* 2. Workshop Title:

Question Title

* 3. Abstract: (50 word or less)
Please provide a brief description of your presentation. This will be printed in the Retreat Booklet.

Question Title

* 4. Workshop Description: (250 words or less)
Please describe the workshop’s overall purpose and content. Describe how your workshop addresses the priority areas listed above.

Question Title

* 5. At which time would you like to present?
Please rank in order of preference.

9:30am-10:45am

I have no preference.

11am-12:15am

I have no preference.

1:30pm-2:45pm

I have no preference.

3:00pm-4:15pm

I have no preference.

Question Title

* 6. Lead Presenter Contact Information:

Name: *

Title: *

Company: *

Address: *

City/Town: *

State: *

ZIP: *

PGPs (Personal Gender Pronouns) Used:

Email Address: *

Phone Number: *

Question Title

* 7. Lead Presenter’s Bio/Experience/Expertise (50 words or less):
Please provide a brief description of yourself and your experiences related to the workshop topic (leadership positions, relevant volunteer work, professional presentations, works published, research, interests, etc.)

Question Title

* 8. Co-Presenter Contact Information:

Name:

Title:

Company:

Address:

City/Town:

State:

ZIP:

PGPs (Personal Gender Pronouns) Used:

Email Address:

Phone Number:

Question Title

* 9. Co-Presenter’s Bio/Experience/Expertise (50 words or less):
Please provide a brief description of your co-presenter and their experiences related to the workshop topic (leadership positions, relevant volunteer work, professional presentations, works published, research, interests, etc.)

Question Title

* 10. Presentation Style:

Lecture

Interactive Activity

Panel Discussion

Open Discussion

Question Title

* 11. Equipment Needs:
(NOTE: All workshop rooms will be equipped with flipcharts pad and markers.)

Slide Projector

Overhead Projector

LCD Projector

DVD/TV

VCR/TV

CD/Cassette Player

Speakers for iPod/MP3 player

No equipment necessary

Other (please specify or write N/A if no equipment requested):

Question Title

* 12. Accessibility Needs:

	Yes	No
Do you need a transmitter and receiver to aid in hearing?	Do you need a transmitter and receiver to aid in hearing? Yes	Do you need a transmitter and receiver to aid in hearing? No
Do you need a mobility scooter?	Do you need a mobility scooter? Yes	Do you need a mobility scooter? No

Other (please specify)

Common Threads 2017 - Youth Workshop Submission Form

Question Title

* 1. Please check the topics that your workshop covers:

Question Title

* 2. Workshop Title:

Question Title

* 3. Abstract: (50 word or less)
Please provide a brief description of your presentation. This will be printed in the Retreat Booklet.

Question Title

* 4. Workshop Description: (250 words or less)
Please describe the workshop’s overall purpose and content. Describe how your workshop addresses the priority areas listed above.

Question Title

* 5. At which time would you like to present?
Please rank in order of preference.

Question Title

* 6. Lead Presenter Contact Information:

Question Title

* 7. Lead Presenter’s Bio/Experience/Expertise (50 words or less):
Please provide a brief description of yourself and your experiences related to the workshop topic (leadership positions, relevant volunteer work, professional presentations, works published, research, interests, etc.)

Question Title

* 8. Co-Presenter Contact Information:

Question Title

* 9. Co-Presenter’s Bio/Experience/Expertise (50 words or less):
Please provide a brief description of your co-presenter and their experiences related to the workshop topic (leadership positions, relevant volunteer work, professional presentations, works published, research, interests, etc.)

Question Title

* 10. Presentation Style:

Question Title

* 11. Equipment Needs:
(NOTE: All workshop rooms will be equipped with flipcharts pad and markers.)

Question Title

* 12. Accessibility Needs:

Question Title

* 13. Meal Options:
Please let us know if you have any allergies or religious/dietary restrictions.

Question Title

* 14. Do you have any other comments, questions, or concerns?

Question Title

* 1. Please check the topics that your workshop covers:

Question Title

* 2. Workshop Title:

Question Title

* 3. Abstract: (50 word or less)Please provide a brief description of your presentation. This will be printed in the Retreat Booklet.

Question Title

* 4. Workshop Description: (250 words or less)Please describe the workshop’s overall purpose and content. Describe how your workshop addresses the priority areas listed above.

Question Title

* 5. At which time would you like to present?Please rank in order of preference.

Question Title

* 6. Lead Presenter Contact Information:

Question Title

* 7. Lead Presenter’s Bio/Experience/Expertise (50 words or less):Please provide a brief description of yourself and your experiences related to the workshop topic (leadership positions, relevant volunteer work, professional presentations, works published, research, interests, etc.)

Question Title

* 8. Co-Presenter Contact Information:

Question Title

* 9. Co-Presenter’s Bio/Experience/Expertise (50 words or less):Please provide a brief description of your co-presenter and their experiences related to the workshop topic (leadership positions, relevant volunteer work, professional presentations, works published, research, interests, etc.)

Question Title

* 10. Presentation Style:

Question Title

* 11. Equipment Needs:(NOTE: All workshop rooms will be equipped with flipcharts pad and markers.)

Question Title

* 12. Accessibility Needs:

Question Title

* 13. Meal Options:Please let us know if you have any allergies or religious/dietary restrictions.

Question Title

* 14. Do you have any other comments, questions, or concerns?

* 3. Abstract: (50 word or less)
Please provide a brief description of your presentation. This will be printed in the Retreat Booklet.

* 4. Workshop Description: (250 words or less)
Please describe the workshop’s overall purpose and content. Describe how your workshop addresses the priority areas listed above.

* 5. At which time would you like to present?
Please rank in order of preference.

* 7. Lead Presenter’s Bio/Experience/Expertise (50 words or less):
Please provide a brief description of yourself and your experiences related to the workshop topic (leadership positions, relevant volunteer work, professional presentations, works published, research, interests, etc.)

* 9. Co-Presenter’s Bio/Experience/Expertise (50 words or less):
Please provide a brief description of your co-presenter and their experiences related to the workshop topic (leadership positions, relevant volunteer work, professional presentations, works published, research, interests, etc.)

* 11. Equipment Needs:
(NOTE: All workshop rooms will be equipped with flipcharts pad and markers.)

* 13. Meal Options:
Please let us know if you have any allergies or religious/dietary restrictions.