Osher Institute Proposal Form

TODAY'S DATE:

Name and Contact Information

NAME: *

Prefix First Last

Please provide a phonetic pronunciation of your first and last name.

ADDRESS: *

Street Address City State / Province / Region ZIP / Postal Code

EMAIL ADDRESS: *

PHONE NUMBER: *

CELL PHONE NUMBER:

EMERGENCY CONTACT NAME: *

First Last

CONTACT'S PHONE NUMBER: *

If you are currently (or have been) employed at Boise State, please enter your employee ID number:

Program Proposal Information

Topic/Title: *

This is a proposal for a (check one): *

Lecture (One session, two hours in length.)
Short Course (Two, three, or four sessions, each two hours in length. Meets same day/time each week for the duration.)
Special Event (Tours, trips, or other unique one-time opportunities.)
Workshop (Designed for hands-on activity or a small audience for deeper dive on subjects with interactive discussion.)

Program Proposal Description

Please provide a brief description of your program (max. 100 words). *

Title and description may be edited for grammar, spelling, and length for use in the Osher Institute print and online catalog.

Scheduling Preferences

Preferred day of the week (check one): *

Monday
Tuesday
Wednesday
Thursday
Friday (morning only)
Saturday (morning only)

Preferred time (check one): *

10:00 a.m.-12:00 p.m. (MST)
1:30 p.m.-3:30 p.m. (MST)
I have no time preference

Semester to take place: *

(NOTE: Proposals received after the deadline will be considered for the following semester.)

Fall (August - December, deadline is February 1)
Spring (January - May, deadline is August 1)

Brief Biography and Photo

Please email your headshot photo to osher@boisestate.edu. Provide your brief bio below for the Presenter Bios page of the Osher website.

Anticipated Equipment and Material Requirements

Please provide your anticipated special materials/equipment/audio-visual needs.

Our classrooms come equipped with a computer, projector, screen, lapel or headset microphone, and a slide clicker.

Speaker Status

Please select your preferred method of payment. *

The Osher Institute can provide a modest honorarium to speakers. Please select one of the following:

Thanks, but I'll waive the honorarium. (Thank you. The funds will remain in the Osher Institute operating budget to support a full year of programs as well as staff time and materials.)
I'd like to receive a one-year Osher Institute membership (value of $200) in lieu of an honorarium.
If my program is selected, I'll accept the honorarium as a Boise State full-time, benefits-eligible faculty/staff member and be paid via payroll. I have included my Boise State employee ID number above.
If my program is selected, I'll accept the honorarium as a Boise State full-time faculty member and have the fund transferred to my department. I will email my department's budget account strand to osher@boisestate.edu.
If my program is selected, I'll accept the honorarium as a Boise State part-time, adjunct faculty member and be paid via payroll. I have included my Boise State employee ID number above.
If my program is selected, I'll accept the honorarium as an Independent Contractor (not employed at Boise State) and agree to complete the onboarding documents as directed and by the deadlines provided. Failure to do so may result in the honorarium not being provided.

NOTE: Graduate students employed at Boise State may receive payment via Boise State payroll for a one-time lecture with the Osher Institute. If you are a graduate student, please provide your Boise State ID#, email address, and phone number below.

Consent *

By submitting this proposal, I understand that, if selected, the presentation may be recorded for the viewing of Osher members unable to participate in the live event.

I understand that selected proposals are added to Osher's Archived Programs list.

I understand that the Osher Institute prohibits any fundraising efforts or petitions to be promoted during a presentation.

I agree to the statements.

Thank you for taking the time to complete this proposal form. We look forward to reviewing it.

When you submit this form, an email will be sent to you as a record of the information you provided.

You will be notified of your proposal acceptance shortly after August 1 for Spring scheduling and February 1 for Fall scheduling.

** PLEASE NOTE: After clicking "Submit," DO NOT close the browser window until you receive a confirmation message that your proposal was received, as it sometimes takes a few seconds to process. If you have submitted the form correctly, you will receive a confirmation email with a copy of the information you provided.