Thank you for your interest in the Montana Conversations program. We are accepting applications until midnight (MST), March 20, 2012.

If you have any questions about this form, please contact Program Director Kim Anderson via email or at 406-243-6022 or 1-800-624-6001.

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First Name	Last Name

Proposed Program Title

HOME CONTACT INFORMATION

Home Mailing Address

City	State	Zip
	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, DC West Virginia Wisconsin Wyoming

Home Email

Home Phone	Home Cell Phone

WORK CONTACT INFORMATION

Company Name

Work Mailing Address

City	State	Zip
	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, DC West Virginia Wisconsin Wyoming

Work Email

Work Phone	Work Cell Phone

CONTACT PREFERENCES

Preferred phone/email for contacts from public?

Home Work

Preferred phone/email for contacts from Humanities Montana

Home Work

HISTORY AS A PUBLIC SCHOLAR

Have you worked with Humanities Montana in the past? If so, in what capacity?

Are there videos, audio recordings, or publications (online, in print, or on CD/DVD) that might help us understand better your work as a public scholar or your interest in and knowledge about this topic? If so, please provide URLs and/or citations here, or note that you'll be mailing materials separately.

What is your interest and/or background in public scholarship and facilitating public conversations?

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PROPOSED CONVERSATION PROGRAM

Proposed Montana Conversation Program

Humanities Montana Speakers Bureau Humanities Montana Speakers in the Schools

Please provide a short description for your proposed program. Note: If your proposal is accepted, we may edit this description for our catalog.

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Describe your personal and/or professional interest and background in the proposed topic.

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From which humanities disciplines will you draw?
Literature History Cultural studies Native American studies Political science International studies Sociology Folk traditions	Anthropology Archaeology Art history and criticism Philosophy Ethics Linguistics Jurisprudence Religious studies

How will you integrate these disciplines in your presentation and conversation?

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Please provide at least three questions and/or activities that you will use to stimulate discussion and engage participants in your program.

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What specific media (i.e., short readings, film clips, images, songs, etc.) will you use to engage participants during your program?

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Provide full contact information, including phone and email, for two references—please select references who can discuss your expertise related to your proposed topic, your experience engaging audiences and any related experience facilitating public dialogue.

Reference 1

Reference 2

Provide a sample list of no more than ten readings, websites, podcasts, films, or other resources that participants could explore to pursue their interest in your given topic after the program.

Please note: the form cannot be saved mid-progress.

It's recommended that you draft, edit, and proofread your responses in a word processing program first, then copy-and-paste the final versions just prior to submitting the form.