Workshop Presentation Form
for Distinguished Membership Points

We recognize that KDP: Tau Epsilon Chapter is not the only organization to provide opportunities for educators to share their knowledge with their peers and colleagues. We want to commend you, and award you distinguished membership points, for your volunteerism as you share your experience and expertise via workshop and/or panel discussion presentation. In order to receive credit for your outside event involvement you must document the items found in the form below. Once your presentation is complete please fill out this form and submit it for credit. The Membership Chairperson will follow-up with you once the submission is received and processed.

KDP Member Information
1. Your Name:
        (first and last)
2. Your E-mail*:
        *must enter this field to successfully submit this form
3. Your Member #:
        (if known)

Conference/Event Information
4. Name of conference/event where workshop/panel is presented:
5. Name of sponsoring organization:
6. Date(s) of conference/event:
7. Location of conference/event:

8. Are you volunteering your time?yes no
9. Are you presenting alone OR with co-presenters/panelists?
10. Length of presentation:
11. Title of your presentation:
12. Date & Time of your presentation:
13. How far did you travel to present?

14. What is the focus of your presentation?

15. How do you prepare for your presentation?


16. Describe the best benefit of presenting:

17. Describe the worst drawback to presenting:


18. Were your expectations for the presentation fulfilled?
yes no
19. Why or why not?


20. Do you plan to present this material again? yes no
21. If you answered yes to #20, what, if anything, will you change for your next presentation?


Presentation Verification
In order to complete the submission process we must be able to verify
your involvement with the event. Please provide the following information
for us to contact the event coordinator who can confirm your answers
in questions 4-12 above.
22. Name of event coordinator:
23. E-mail of event coordinator:
24. Phone # of event coordinator: