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.

* 1. Name of the School Division

* 2. Contact person for the workshop

* 3. E-mail Address for the Contact Person

* 4. Phone Number for the Contact Person

* 5. Fax Number for the Contact Person

* 6. Workshop Preference

  First Choice Second Choice Third Choice
Full Day (including lunch)
Full Day (exclude lunch
½ Day

* 7. Timing of the Workshop

  First Choice Second Choice
Spring (During the regular work week)
Summer (After June 15th)

* 8. Estimated Number of persons that Would Attend

* 9. Cost sharing method (Maximum Amount to be paid by division)

* 10. Cost sharing method (Maximum Amount to be paid by division per person)

* 11. Maximum Cost Per Division, if division charge is used instead of a per person cost

* 12. Other Comments