Panel Presenter Application

Applicant Name: Title:

School/Organization Name:

City: State: Zip:

Phone Number: Email:

Which curriculum(a) have you taught? (check all that apply):

Reducing the Risk BART Keepin' It REAL TimeWise

On which curriculum are you interested in presenting your experience? (check one):

Reducing the Risk BART Keepin' It REAL TimeWise

Please answer the following questions to give us a picture of your experience teaching the curriculum.

Briefly describe the community(ies) in which you have taught the curriculum (e.g., rural, primarily African-American and Latino, a religiously conservative suburb, etc.).

Briefly describe the youth and the setting in which you've taught the curriculum (e.g., academically oriented youth in after school program, girls ages 13-16 years old in a private school, etc.).

Describe your experience teaching the curriculum, including how long and how often you have taught it.

How have you taught the curriculum to address the unique needs/perspectives of your youth?

Describe how closely you follow the curriculum as it is written.

How many lessons of the curriculum did you usually teach? And to how many youth?

Is there something specific you want to share about your experience with the curriculum?

To submit this application, press the SUBMIT button. Press the RESET button if you want to start over. Applications are due by March 15, 2006.