Workshop Proposal Form 2018

Workshop Proposal Form

EDGY 2025: Queer Horizons- Helping LGBTQ+ Youth Navigate Mental Health, Community, & Identity
Primary Facilitator Information
Name*

First NameLast Name
E-mail*
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Phone Number*

Area CodePhone Number
Address

Street Address

Street Address Line 2

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Presenter Bio*

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Will you be travelling from outside of Southern California? If Yes, Where from?*
CIty and State
Degree (if applicable- i.e. BA, BS, Ph.D, MSW, etc.)*
Brief Description of Your Qualifications (why are you qualified to present on this topic?)*
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Presenter Resume*

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Presenter Headshot/Photo*

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Agency, Company, Organization or School*
Additional Facilitators*

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If YES, please list the First and Last names (and Email Addresses) of Additional Facilitators
Will a Panel be included?*

YesNo
If YES, please list the First and Last names (and Email Addresses) of Panelists