University of Illinois at Springfield

ECCE Speaker Series Proposal Form

Directions: Please complete all sections of the form below and email the completed form to Chasity Bree (). If you have any questions, contact Chasity at 206.8171. All proposals will be reviewed by the Office of Undergraduate Education and assessed for relevance to ECCE. Those proposals with a strong tie to ECCE will be forwarded to the General Education Council for review and approval.

Students and community members should work with a UIS staff or faculty co-sponsor. The ECCE Speaker Series does not accept direct solicitations from speakers or their agents.

Requestor’s Contact Information

Today’s Date:
Event Proposer’s Name:
UIS Department / Affiliation:
Email Address:
Phone Number:
Faculty / Staff Sponsor:
Faculty / Staff Sponsor’s Signature:

Event Information

Type of ECCE Speaker Series Proposal:
See instruction sheet detailing each proposal type. / ___Participation Proposal (No budget information required.)
___Co-Sponsorship Proposal(Budget information consists of specific contribution requested.)
___ Full Proposal(Full budget required.)
Requested Semester for Event: / ____Fall ____Spring ____Summer Calendar Year: ______
Tentative Event Title:
PresenterName(s):
Brief Description of the Event:
Description will show in our event schedule.
Limit to 150 word count.
Event Type:
Lecture, panel, workshop, film, etc.
Audience Participation Component:(ex. Q&A, Discussion, etc.)
Brief Biography of Presenter(s):
This brief bio will show in our event schedule.
Limit to 150 word count.
Include links to presenter’s website, if there is any.
Please attach a copy of presenter’s vita with this proposal.
Presenter(s) Contact Information:
Email address, phone number, agent’s name & contact information, if applicable.

ECCE Relevance (Synopsis and Explanation)

Please note that this section is about the proposed event itself and not about the presenter.

Please provide a three-sentence synopsis of the event’s relevance to ECCE. This synopsis will be added to the event description in the event schedule. Use this synopsis to answer questions in ‘Explanation’ section.

  1. Synopsis:
  1. Explanation: Please explain how the proposed event ties into the ECCE themes and / or ECCE courses by answering TWO of the following questions (a-f).
  1. How does the proposed event allow students and the general audience to recognize their social responsibility toward their larger community?
  1. How does this event lead to awareness of and respect for the diversity of cultures and peoples in this country and in the world?
  1. How does the event lead to reflection on the ways involvement, leadership, and respect for community occur at the local, regional, national, or international levels?
  1. Does the event identify how economic, political, and social systems operate now and have operated in the past? How so?
  1. Does the event engage the audience in an open-minded and ethical decision-making and action? In what ways?
  1. Does the event provide knowledge that could lead to reflection on the distinction between the possibilities and limitations of social change? Explain.

Event Details

Requested Date of Event:
Estimated date is fine.
Preferred Event Start Time:
(morning, lunchtime, afternoon, evening, weekend)
Preferred Venue:
(Brookens Auditorium, PAC conference room, etc.)
List Potential / Probable Event Co-sponsors:
Has initial contact been made to presenter to gauge willingness / interest to come to UIS? / ____ NO
____ YES
Do we have permission to record the proposed event and post it on our Video on Demand site ( for public viewing? / ____ NO
____ YES

Additional Notes

List any additional notes or comments about the event and / or this proposal:

NOTE 1: ECCE Speaker Series does not arrange classroom visits, faculty meetings / workships or meals with the presenter(s). We do, however, encourage you and / or your department to make these arrangements on your own. We certainly want you to make the most out of your presenter’s visit to our campus!

NOTE 2: If your proposal is approved, you will have to provide the ECCE Speaker Series with a photo of the speaker or activity that will be used in the event schedules that will be disseminated to students and the public. You are responsible for getting permission for our use of the photo.

NOTE 3: If your proposal is approved, you will be responsible for making sure that you represent our program well to your invited guests (i.e. hosting them while in Springfield, arranging their local transportation, etc.).

ECCE Speaker Series Funding Requested


Participation Proposal: No budget information needed. This completes your proposal form.

Co-Sponsorship Proposal: List the amount of funding requested from ECCE Speaker Series.
$ ______
Please describe the anticipated types of expenses that will be covered by this
funding request.
No additional budget informationrequired. This completes your proposal form.
Full Proposal: Continue to the next page and complete the detailed budget worksheet.

Preliminary Speaker / Event Budget Worksheet

Note: This worksheet is to be completed ONLY for a Full Proposal. The purpose of this worksheet is to estimate the total costs for your event. It is understood that these costs (other than honorarium) are approximate.

HONORARIUM / SPEAKING FEE
Honorarium / Speaking Fee:
ECCE Speaker Series does NOT reimburse presenters for meal expenses, nor is a meal allowance or per diem given. If presenters expect to have their meals covered, please figure these costs into the honorarium / speaking fee. / $ ______
TRAVEL EXPENSES
Number of Presenters Traveling to UIS: / # ______
List City / Airport From Which Each Presenter Will Travel:
If more than one person traveling from different locations, please list all starting locations.
Airfare:
Please get airfare estimatesfrom Expedia or another online travel site. / $______
Ground Transportation To / From Hotel andAirport:
Home to Airport
Springfield Airport to Hotel**
Hotel to UIS
Subtotal x 2
**Proposer is responsible for arranging local transportation of the invited presenter(s). / List mode of transportation (train, taxi, rental car, etc.) and approximate ground transportation costs for each presenter.
$______
Approximate Mileage if Presenter Driving OR if You Are Going to Transport Presenter:
Number of Milesx 56Cents / Mile / $ ______
LODGING
Hotel Costs:
Figure Government Rate x # Nights x # Rooms / Nightly Hotel Rate: $ ______
Number of Nights: ______
Number of Rooms: ______
Estimated Total Hotel Costs: $ ______
OPTIONAL POST– EVENT RECEPTION
Approximate Reception Food Costs:
Consult UIS Food Service Catering for menuoptions and pricing. / Due to the budget crisis, Speaker Series will NOT fund any food costs at this time.
OTHER COSTS
Other Costs:
Examples include film purchases and screening licenses, space rental if requesting Studio Theatre, etc. / List item and associated cost.
$ ______
TOTAL EVENT COST
TOTAL ESTIMATED EVENT COST: / $ ______