"Call for Presentations” Application Form

Deadline December 14, 2007

Presenter Information
The contact information submitted will be the contact for all subsequent communications regarding presentation at the conference.

Title

First Name *

Middle Initial

Last Name *

Job Title

Organization

Address 1 *

Address 2

City *

State *

Zip Code *

Telephone *

Fax

Email *

Website/Blog

Presenter Biography
Tell us about your background and experience as it relates to the presentation you are submitting. Please limit to 200 words. If more than 200 words are submitted, the biography may not be saved in its entirety *

If your presentation will include other presenters, please enter the information below. If you know others will present, but have not determined the specific person, please indicate TBD in the name section.

Additional presenters
Additional Presenter #1
First Name

Last Name

Title

Organization

City

State

Additional Presenter #1 Biography

Additional Presenter #2
First Name

Last Name

Title

Organization

City

State

Additional presenter #2 biography

Additional Presenter #3
First Name

Last Name

Title

Organization

City

State

Additional Presenter #3 biography

Additional Presenter #4
First Name

Last Name

Title

Organization

City

State

Additional Presenter #4 biography

Presentation Information
Which best describes the community in which your model is working? Please check all that apply.
Urban
Rural
Reservation

Organization Address
City

State

Region Served

Reservation

1. Presentation Title *

2. The type of model (Check one or two – Advocacy models can also fall under the emerging or tested categories). A majority of the models selected will fall into the tested category. *
Emerging models/programs, tools or ideas in poverty reduction
Tested models or tools for community-based poverty reduction
Advocacy models or tools that increase community involvement

3. Model summary – 350 words maximum. Please describe
• Describe the specific problem that is being addressed by the model/program.
• Describe the organization(s) involved in the model/program and their role(s).
• Describe the specific goals and measurable outcomes and specifically how the model/program is being evaluated.
• Describe the implementation process, including the timeframe, and what was required to make the model operational (legislative legal, financial, staffing, etc.).
• Outline the cost structure and/or delivery costs
• Describe how the model/project is working to date, including the outcomes and impact.
• Identify lessons learned
• Conclusions – an explanation about how and why this model works; what makes it work.
*

4. Tools
Briefly describe (in one or two sentences) one or two tools used within your model. Specifically identify the take-aways or content that will be distributed to session attendees (assessment process, curriculum, online tool, etc). *

5. Evaluation/ Outcome Data
Briefly describe your evaluation methodology and analysis. If you submitted a model under the emerging category, please explain your plans for evaluation. A presentation submitted without evaluation criteria will not be considered. *

6. Three main learning objectives - or key points – that you will make (e.g., at the end of the session, attendees should be able to…”
Objective 1 *

Objective 2 *

Objective 3 *

7. Mini-description
Please provide a short – 100 words or less – description of your model. Please be sure to indicate the model’s relevance to poverty reduction. (The theme is Sharing What Works to Reduce Poverty and Grow Community Prosperity. The goal is to provide a place and time for communities to share working models that can be examined and considered for adoption or adaptation in other communities.) *

8. Reference information
If you have previously presented your model, or have made any presentations at other conferences or meetings, please provide a short list of these occasions. Thank you. *

Presentation Title *

Presented to (name of organization) *

Date (if exact date is not known, please indicate year) *