SIOA Workshop Submission

Deadline: November 30, 2009
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Lead Presenter
Name:
Title:
Agency/Organization:
Address Line 1:
Address Line 2:
City:
State: Zip:
Business Phone:
Fax (Optional):
E-mail:
Co-Presenter 1 (Optional) Co-Presenter 2 (Optional)
Name:
Title:
Agency/Organization:
Address Line 1:
Address Line 2:
City:
State: Zip:
Business Phone:
Fax (Optional):
E-mail:
Name:
Title:
Agency/Organization:
Address Line 1:
Address Line 2:
City:
State: Zip:
Business Phone:
Fax (Optional):
E-mail:
  1. Proposed Title of Workshop (10 words or less): .
  2. Length of Workshop:
    90 minutes
    3 hours
    1 hour networking
  3. Have you presented this (or a similar) topic before? Yes No
    • If yes, please list a date and location, and give the contact information of one person that heard your presentation and can provide a brief evaluation.
      • Date:
      • Location:
      • Contact Information:
    • If no, please list a professional reference (name and contact information) we can contact who can speak to your ability to present this information.
  4. Please indicate your choice of maximum class size:
    40
    50
    75
    100+
  5. Focus Area (what major area of practice does the proposal content best address):
    Holistic healthy aging
    Service delivery competencies
    Aging and health policy
    Caregiver issues
    Safety and Environmental Issues
    Engaging Post-Retired Adults
    End of Life Care
    Creativity in Aging
    Mental Health/Substance Abuse/Drug Aversion
    Effective/Innovative programs for providing aging services
    Timely topics related to the field of aging
    The role of race, culture and spirituality in aging services
    Ethics
    Aging in rural areas
    Enhancing communication and collaborative efforts among professionals
    Achievements of older individuals and their contributions to their communities and/or the field of aging
  6. Difficulty Level:
    Introductory
    Advanced
  7. Track (choose one or two):
    Clinical/Mental Health Practice
    Management/Administration/Policy
    Cultural Competence/Diversity
    Core Practice
  8. Audio Visual Equipment: Presenters will be supplied with standard audio visual equipment if requested.
    The equipment that could be provided is listed below (check all required items):
    Overhead Projector
    Screen
    LCD Projector
    Laptop Computer
    TV/VCR Combo
    Flipchart/Markers
    Microphone/Speaker System
    DVD Player
  9. Abstract including brief summary of content, presentation format (in particular how you will provide experiential learning opportunities for participants), outline of learning objectives, and target audience (500 word maximum):
  10. Workshop Description for Advertising Purposes (one paragraph of 50-100 words):
  11. Key Learning Objectives of the Workshop (must have at least four):
  12. Describe how your presentation relates to the theme of the conference and the focus area that you selected:
  13. One Question and Answer From Your Presentation for Nursing CE Testing:
  14. Brief Bio (200 word maximum) – submit for each presenter:
  15. Resume/CV (submit one for each presenter). If you prefer to submit as an attachment, please e-mail to Jacki.Englehardt@mail.wvu.edu:

* A copy of this proposal will be sent to the Lead Presenter at the email address provided.
 
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Contact: Jacki Englehardt MSW, ACSW
Coordinator of Professional & Community Education
WVU Division of Social Work
PO Box 6830
Morgantown, WV 26506-6830
Phone: 304-293-3501 ext. 3109
Fax: 304-293-5936
Email: Jacki.Englehardt@mail.wvu.edu