2023 WA State DEI Conference Presenter Application Form

1

We have designed this step by step guide to reduce barriers to your engagement as a potential presenter at this year’s WA DEI Empowerment Conference. Do you have questions? Join us for one of our information sessions over Zoom. Click the Arrow to Download

2

Presenter Contact NameThis will be your main contact. You will be provided space below for additional presenter information.

First Name

Last Name

Pronouns

3

Company Name as Applicable. If not applicable place a N/A in the box.* This field is required.

4

City* This field is required.

5

State* This field is required.(Please select your state)

6

Your Web Site (if applicable)

7

Phone Number* This field is required.

Area Code

Phone Number

8

E-mail* This field is required.

example@example.com

Confirm Email

9

Why do you want to be a presenter at the 2023 Washington State Employee DEI Empowerment Conference?* This field is required.

10

Title of Your Session:* This field is required.The title of your session is the first impression for Conference Attendees. Use a concise, but inclusive, title which clearly conveys what you will be presenting and draws attendees' attention to your topic.

11

Category* This field is required.Identify which of these four topic areas your presentation aligns with. If your presentation fits outside of these categories, please select "Other" and provide a description.

12

Gap Area/Focus Area* This field is required.The Washington Employee DEI Empowerment Conference Coordinators have survey employees across the enterprise to identify gaps on knowledge or skill. With the 2023 theme of "Bridging Gaps and Leaning into Action" we are focusing this year's presentations on gap/focus areas listed below. What Gap is your session focusing on? Please select all that apply. If your presentation fits outside of these gap/focus areas, please select "Other" and provide a description.

13

Gap Area/Focus Area Described : Describe how your proposed presentation addresses one or more of the identified gaps / focus areas. Written response must include explanation of how the gap is bridged/addressed in the course.* This field is required.

14

Abstract: Your session abstract will tell Conference Attendees why they should attend your session. To be effective and create interest, it should provide a brief, clear, and concise reflection of your presentation’s content. The abstract should only be one paragraph of 150 to 250 words in length.* This field is required.How you will provide content? (speaker panel, storytelling, the use of polls, small group activities, videos, etc.)

15

Key Takeaways or Learning Objectives. List key takeaways that learners can expect to obtain from your presentation.* This field is required.

16

Describe your experience in providing a welcoming learning environment for participants of diverse and intersectional identities with unique lived experience, abilities, and backgrounds. * This field is required.

17

Target Audience* This field is required.We would like to understand what audience(s) your presentation focuses on. Select all that apply

All Employees

Recruiter/Hiring Manager

Executive

Contracts/Contract Manager

Program Manager

People Manager/Supervisor

Educators

Front Line Staff (public facing staff)

Diversity, Equity, Inclusion/Belonging, Accessibility Practitioners

19

Audience Knowledge and Experience* This field is required.What is the base knowledge that you expect learners to have prior to attending your presentation? Please select the appropriate knowledge level from the options provided below. This list is from OFM's Enterprise DEI Competencies - All Employees - A pathway for success

20

Are we able to record your presentation?* This field is required.

YESNO

21

Please upload an example of what you will be presenting or something similar.A project proposal or outline is acceptable to provide here, include how you will provide content such as (speaker panel, storytelling, the use of polls, small group/breakout room activities, etc.).

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

22

Presenter #1 Name (Please include Name and Pronouns)

23

Presenter #1 Gender Identity

24

Presenter #1 Race and/or Ethnic IdentitySelect all that apply.

25

Presenter #1 Do you identify as having a disability?

YESNO

26

Presenter #1 Are you a U.S. Veteran?

YESNO

27

Bio for Presenter # 1* This field is required.

28

Do you have additional presenter information to provide?

YESNO

29

Presenter #2 Name (Please include Name and Pronouns)

30

Presenter #2 Gender Identity

31

Presenter #2 Race and/or Ethnic IdentitySelect all that apply.

32

Presenter #2 Do you identify as having a disability?

YESNO

33

Presenter #2 Are you a U.S. Veteran?

YESNO

34

Bio for Presenter # 2

35

Do you have additional presenter information to provide?

YESNO

36

Presenter #3 Name (Please include Name and Pronouns)

Please include Name and Pronouns

37

Presenter #3 Gender Identity

38

Presenter #3 Race and/or Ethnic IdentitySelect all that apply.

39

Presenter #3 Do you identify as having a disability?

YESNO

40

Presenter #3 Are you a U.S. Veteran?

YESNO

41

Bio for Presenter # 3

42

Do you have any additional presenter information to provide?

YESNO

44

Presentation Fees* This field is required.What is the estimated fee you intend to charge for a 90-minute presentation? Please make sure to accommodate for any extra time you may need to make sure your materials are ADA accessible and for completing the necessary vendor registration forms to ensure easy payment from the State of Washington. (State Employees please review ethics rules RCW 42.52.120 on Compensation for outside activities and RCW 42.52.130 on Honoraria)

45

Presentation Fees Attachments (Optional)Provide any additional documentation, detailed pricing, etc. related to cost of presentation.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

46

I agree to work with Washington State Employee DEI Empowerment Conference Coordinators to ensure a final ADA Accessible version of my presentation is submitted by May 1, 2023.* This field is required.

YESNO

47

I have verified that all information provided is accurate and complete* This field is required.

Yes

48

Enter the message as it's shown* This field is required.

Save your progress

Save your progress

Your form submission has been saved as a draft.

Save your progress

Your form submission has been saved as a draft.