Early Implementer Submission Form

VCCS New Horizons 2010: Discover What's Next
Early Implementer Award (EIA)

Hotel Roanoke and Convention Center
April 7-9, 2010

Early Implementer (EIA) Submission Form

Title of Submission: *

Submission Information

Note: 'Limit 180 words' is approximately 1000 characters.

Submission Abstract: This text will appear in program (limit 180 words).*

Describe submission use in learning environment: (limit 180 words).*

Describe the submission's impact: (limit 180 words).*

New Horizons Conference year from which you recieved your inspiration:
20082009

Name of Presenter or Session Name:(optional)

What area/discipline is the project created for and/or used in?

My submission/project extends to or affects:

Do you intend to continue to use this idea?
YesNo

How much of the original idea did you implement?
5%
25%
50%
75%
80-100%

Lead Submitter's First Name:*

Lead Submitter's Last Name:*

Lead Submitter's Job Title:*

Lead Submitter's Email:*

Re-enter email address:*

Lead Submitter's VCCS College or Agency:

Lead Submitter's Contact Phone:*

Co-Submitter's First Name:

Co-submitter's Last Name:

Co-submitter's Email:

Co-submitter's Job Title:

Co-submitter's College or Agency:

Enter the code shown above:

*Required