YouthCaN 2005
Project and Presenter Application Form

APPLICATION DEADLINE January 15, 2005

This application is for those who are interested in presenting their project at YCNYC 2005 or collaborating on a student environmental project by sharing their project online. The Conference will be held at the American Museum of Natural History on Monday, April 11, 2005.

Submit this application by printing it and mailing or faxing it to us or by copying it and pasting it into an e-mail message and e-mailing it. See address information below.

Contact information

Primary Contact Person: ____________________________________________________

Name of School/Organization: _______________________________________________

Street Address: _________________________________________________________

City: ______________________________________ State/Province: _________________

Zip/Postal Code :_________________ Country: ____________________________

Telephone: _________________________ Fax: ____________________________

E-mail Address: _________________________@__________________________

Age range of students from your school: ______________ - ________________ years

Number of representatives from your team: ______________

Have you attended Youth CaN before? _______ When/Where? ______________

Project Information

Are you looking for a project to join? ____ Yes

If yes, what are your areas of interest?

____________________________________________________________

____________________________________________________________


Are you looking for groups to join YOUR project? ____ Yes

Do you have a partner(s)? ____ Yes

If yes, who are they?
Contact person(s) and Organization(s):

____________________________________________________________

Your Project Title:

____________________________________________________________


Your Project Description:
(Please write your description below as you would like it to appear in the conference registration form. Teachers and students will be reading these descriptions when they choose which workshops they would like to attend.) Click here to view past project descriptions.

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

This project is appropriate for students ages ______ through _______ years

Project participants can communicate via:
_____ e-mail?
_____ video conference?
_____ telephone?
_____ fax?
_____ Other

Option 1: NYC Presentation Information

If you wish to present your project at the YouthCaN conference in New York fill out this section. If you do not know all of the details at the moment fill in what you can and we will get back to you in February.

We would like to present our project at YC 2005 on April 11, 2005 in New York City _____ Yes

Our Youth Presenters:
1) _______________________ e-mail address: ________________________
2) _______________________ e-mail address: ________________________
3) _______________________ e-mail address: ________________________
4) _______________________ e-mail address: ________________________

Would you present in person? _____ Yes or...
Would you like to present via video-conference connection from your area? ____ Yes

What type of presentation would you like to give?
_____ Hands-on workshop
_____ Discussion group
_____ Theatrical
_____ Game
_____ Other: ________________________________________________

What equipment do you need?

Macintosh Windows
Number of computers . .
Yes No
Do you require computer projection? . .
Do you require Internet access? . .
Do you require an overhead projector? . .
Do you require a slide projector? . .
NTSC/US PAL/International
Do you require a video cassette player? Which type? . .

What software do you need? _________________________________________

Other equipment needs __________________________________________________


What table and chair requirements do you have for your workshop? _____________________

___________________________________________________________________

Option 2: Display table instead of or in addition to a workshop.

If you would like to display your environmental project(s) in the exhibition area instead of or in addition to a workshop at YouthCaN 2005 in New York, fill out this section of the form too.

Please describe your display (size, subject, equipment and electricity needs):
____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

Please submit this application via postal mail, fax or e-mail.

Mail to: Youth CaN
Education Department
American Museum of Natural History
Central Park West at 79th Street
New York, NY 10024-5192
Fax: (212) 769-5329
E-Mail: youthcan@us.iearn.org

Information/Inquiries: (212) 769-5039