2023 GaTOTY Event Request Form

GaTOTY Event Request Form

Michael Kobito, 2023 Georgia Teacher of the Year
2023 GaTOTY Contact Information
Michael Kobito
2023 Georgia Teacher of the Year
Email: Michael.Kobito@doe.k12.ga.us
Facebook: GATeacher
Twitter:
Organization Contact Information
Name of Organization Requesting Appearance: *
District/School/Institution/Business
Organization Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Point of Contact *

First Name Last Name
Contact Email *

Confirmation Email example@example.com
Contact Phone Number *
Please enter a valid phone number.
Is the contact person for the day of the event the same as above? *

Yes No
Day-of-Event Point of Contact

Complete this section only if different from pre-event point of contact.
Day-of-Event Contact Name

First Name Last Name
Day-of-Event Contact Email

Confirmation Email example@example.com
Day-of-Event Contact Phone Number
Please enter a valid phone number.
Event Details
Event Title *
Event Type *
e.g.: Conference, Workshop, Meeting, Professional Learning Day
Event Attire *

Formal Semi-formal Business Dress Business Casual Casual
Purpose of Event *
This event is a: *

Live In-person event Virtual event Hybrid event
If the event is virtual or hybrid, will a pre-recorded presentation be expected? *

Yes, pre-recorded presentation No, live virtual presentation Hybrid (pre-recorded presentation with live Q&A) Other
Event Start Date and Time *

Month Day Year
Date
Hour Minutes AM/PM Option
Event End Date and Time *

Month Day Year
Date
Hour Minutes AM/PM Option
Audience (Check all the apply) *

K-5 Educators 6-8 Educators 9-12 Educators K-5 Students 6-8 Students 9-12 Students District Administrators School Administrators Community Members Parents Business Stakeholders Elected Officials Other
If "Elected Officials" is indicated above, provide information on offices held.
What is the approximate size of the audience expected? *
Special Acknowledgements Requested
Should the GaTOTY acknowledge any person or group? Provide detailed information.
Venue Details
Event Venue Name *
If virtual event, what platform will be used?
Venue Address (For in-person events only)

Street Address

Building Name or Number

City State / Province

Postal / Zip Code
Presentation Details
Requested Presentation Type *

Keynote Speech Workshop Interview Appearance Only Other
Details for Presentation *
Include theme, preferred topic(s) to be discussed, and the goal(s) of the presentation.
Are multiple presentations expected? *

No, one presentation only Yes, repeated sessions on the same topic Yes, sessions on multiple topics
Explain the expectations for multiple topic sessions if indicated above.
GaTOTY Expected Arrival Date and Time *

Month Day Year
Date
Hour Minutes AM/PM Option
GaTOTY Estimated Departure Date and Time *

Month Day Year
Date
Hour Minutes AM/PM Option
Complete the chart below to indicate the logistics for the presentation.

If multiple appearances are requested during the event, provide the agenda information for each presentation type or appearance that the GaTOTY is expected to attend. (e.g.: Keynote, Breakout, Reception, Workshop, Luncheon, Dinner)
What is the date and timeframe for each presentation or appearance? Add additional lines as necessary. (Keynote, Breakout session, Workshop, Luncheon, etc.) *
Is a PowerPoint requested? *

Yes No
Should requested PowerPoint(s) be provided to the event organizer prior to the event or provided on a flash drive the day of the event? *

Provided prior to event Provided on flash drive day of event Other
What type of room will the presentation(s) take place in? *
Auditorium, Lecture Hall, Meeting/Breakout Room, Classroom, etc.
What is the total seating capacity of the room? *
How many people are expected?
What is the seating arrangement in the room? *

Theater Style Banquet Style Classroom Style Other
What audio visual equipment will be provided? (Check all that apply) *

Projector Screen Computer Speakers/House Sound Interactive or White Board Podium Presentation Remote (clicker) Wireless Handheld Microphone Wireless Lavalier Microphone Wired Microphone Other
Travel Reimbursement
Please Note: Reimbursement for travel expenses associated with the Georgia Teacher of the Year’s appearance at this event are required.

Reimbursement expenses for mileage:
- The State of Georgia rate of reimbursement for mileage, as of January 1, 2022, is $0.585 per mile. Note: Mileage will be charged at the current state per diem at the time of the event.
Reimbursement expenses for meals:
- Appearances that require the GaTOTY to be away for 12 hours or longer will require reimbursement for meals that are not provided during the event.
- The State of Georgia meal allowance is $6.00 for breakfast, $7.00 for lunch, $15.00 for dinner.
- The State of Georgia meal allowance for high-cost areas (Chatham, Clarke, Cobb, DeKalb, Fulton, Glynn, and Richmond counties) is $7.00 for breakfast, $9.00 for lunch, $20.00 for dinner.
Reimbursement expenses for lodging:
- Appearances scheduled prior to noon that are sixty (60) miles or more from the 30101 zip code (Acworth, GA) may require lodging the night prior to the event.
- Lodging is requested for events concluding after 7:00 p.m.
Approximate number of miles to event from 30102 zip code? *
Will meals be provided during the event? (Check all the apply) *

Breakfast Lunch Dinner Breaks Reception No meals provided
Will a lodging reservation be provided the night before the event? *

Yes, a room will be reserved by the organizer No, speaker must secure reservation No, lodging is not required per information above
Will a lodging reservation be provided the night of the event? *

Yes, a room will be reserved by the organizer No, speaker must secure reservation No, lodging is not required per information above
If lodging will be reserved, what is the name and location of the hotel?
Is completion of an expense form necessary for reimbursement of expenses associated with attendance at this event? *

Yes No
If an expense form is necessary, please upload an electronic copy.

Cancel of
Indicate how the reimbursement requests should be submitted. (Check all that apply) *

Reimbursement form will be provided upon arrival Reimbursement form may be emailed Reimbursement form must be mailed An invoice is requested from the GaTOTY A contract/agreement will be written Other
Point of Contact for Reimbursement Forms or Invoice. *

First Name Last Name
Reimbursement Contact Email *
example@example.com
Reimbursement Contact Phone Number *
Please enter a valid phone number.
Mailing Address for Reimbursement Forms or Invoice

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
What is the estimated timeframe for processing travel payment following the event?
30-days, 60-days
Should be Empty:

GaTOTY Event Request Form

2023 GaTOTY Contact Information

Organization Contact Information

Day-of-Event Point of Contact

Event Details

Venue Details

Presentation Details

Complete the chart below to indicate the logistics for the presentation.

If multiple appearances are requested during the event, provide the agenda information for each presentation type or appearance that the GaTOTY is expected to attend. (e.g.: Keynote, Breakout, Reception, Workshop, Luncheon, Dinner)

Travel Reimbursement