15th Annual Student Leadership Conference Call for Programs Step Up and Be the One!

1. 15th Annual Student Leadership Conference Call for ProgramsStep Up and Be the One! Conference Date: November 5, 2011 Deadline for Programs: October 14th, 2011 Program Title _____________________________________________________________________________ _____________________________________________________________________________ [Please provide a program description and a brief biography on the reverse side of this form.] Coordinating Presenter: Name _____________________________________ Title ______________________________________ Institution__________________________________ Address ___________________________________ City, ST, Zip _______________________________ Phone ____________________________________ FAX _____________________________________ Email _____________________________________ Co-Presenter: Name _____________________________________ Title ______________________________________ Institution__________________________________ Address ___________________________________ City, ST, Zip _______________________________ Phone ____________________________________ FAX _____________________________________ Email _____________________________________ PROGRAM TRACK: Please indicate a category for placement of your program: ___ General Student Leader Track (on-campus leadership, skills development, etc.) ___ Leadership in the Workplace Track (skills that are transferable/what employers expect, etc.) ___ Diversity and Leadership Track (awareness, programming, educating, etc.) ___ Advisor/Staff Track (professional training and networking, staff wellness, etc.) __ Community Service Track (service-learning, community service projects, etc.) ___ Would you like to facilitate a discussion group on a particular topic or for a particular group of participants? Topic or group ______________________________________________________________________________________________________ Preferred Group Size for all programs ________ Please indicate your 1st – 2nd preferred time for your program: ___ 11:15am – 12:30pm___ 2:00pm – 3:15pm (Program time assignments based on preference will be emailed to all presenters o/a October 21st ) AV Equipment Needed: ___ Flip chart/markers ___ Audio cassette player ___ 35mm slide projector ___ Overhead projector ___ TV and VCR ___ None needed ___ Computer and projection equipment ___ Other ____________________________________ Classroom Set-up Needed: _____________________ _____________________________________________ _____________________________________________ Other Needs: _________________________________ _____________________________________________ _____________________________________________ _____________________________________________ For More Information Jenn Clark  281-283-2611  clarkjen@uhcl.edu Return completed form to: Jennifer Clark University of Houston-Clear Lake 2700 Bay Area Boulevard, Box 198 Houston, TX 77058-1098 Continue on Reverse

2. Program Description: Brief Biography of Presenter(s) – keep in mind that space in the program will be limited: Please return your form to Jenn Clark – by fax (281-283-2566) or by mail to the address shown on the front of the form, drop it off in campus mail at Box 198, or drop it off in room SSCB 1.204. Educational Sessions are on Saturday, November 5th and are one hour and fifteen minutes long. Presenters are encouraged to allow time for discussion and Q&A. Presenters are expected to provide handout materials as appropriate. A volunteer will be assigned to your session to introduce you and assist you as needed; the volunteer will distribute and collect session evaluation forms. Evaluation data will be available approximately one week after the conference and will be emailed to presenters. Program Description: In the space provided below, please provide a brief program description appropriate for inclusion in the Conference Program. It should include a short paragraph describing your program, level of activity (primarily lecture, highly interactive, etc.) and outcomes desired for participants. We also need a brief biography for inclusion in the Conference Program.