Community Sessions Form
We welcome community-led sessions, facilitated discussions, skill shares, and other informal offerings at DIC5. Not interested in a formal presentation but still want to contribute? Complete this short form and our Program Team will follow up with you.
Section 1: Facilitator Information
1. Name
*
First Name
Last Name
2. Email
*
example@example.com
3. Phone Number (Text)
*
Please enter a valid phone number.
Format: (000) 000-0000.
4. Presenter Occupation
*
5. RID Member Number. Please enter N/A if you are not a member.
*
6. Presenter Bio (100-word limit)
*
7. Presenter Image (File Upload Max 10MB)
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
8. Presenter Resume/Vitae (File Upload Max 10MB)
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
9. Do you have a co-presenter?
*
Yes, please type your co-presenter's name
No
10. Co-Presenter's Full Name
Section 2: Dates Available to Present
11.Select the date(s) you are available to present.
*
Monday, June 22, 2026 (pre-conference also)
Tuesday, June 23, 2026
Wednesday, June 24, 2026
Thursday, June 25, 2026
Friday, June 26, 2026
Section 3: Reasonable Accommodation
12. If you require reasonable accommodation to participate, please describe your request below.
Section 4: Session Information
Please fill out your proposed session in the form below.
13. Is this your first time presenting this topic?
*
Yes
No
14. Session Title
*
15. 1 Minute Pitch: If you are selected, this video may be used as a spotlight feature in DIC5 promotional materials and social media. Please fill this box with a one-minute YouTube video link (unlisted).
*
16. Session Description (2 - 3 sentences)
*
17. Session Objectives - (List a minimum of three specific measurable actions that demonstrate comprehension and integration.)
*
18. Session Format:
*
Brown Bag Session
Facilitated Discussion
Skill Share
Community Conversation
Other
19. Session Length
*
Less than 30 mins
30 minutes
45 minutes
1 hour
More than 1 hour
20. CEU Type
*
Professional Studies (PS)
General Studies (GS)
Power Privilege, and Oppression (PPO)
Open to discussion
None
21. Participant's Level of Knowledge
*
Little / None
Some
Extensive
Teaching
22. Media / Materials (List all print, audio, and visual materials. Indicate who will provide them.)
*
23. Evaluation and Assessment (Describe how you will assess participant learning during and after the workshop.)
*
Section 7: Submission Confirmation
By signing below, yourself as a presenter, “I confirm that the information provided is accurate to the best of my knowledge. I understand this submission does not guarantee selection and that DIC5 reserves the right to schedule, edit, or modify workshop times as needed.”
24. Entering your name below serves as your electronic signature
First Name
Last Name
25. Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: