Proposal 90-min conference ed form

Proposal 90-min 2025 Annual Conference Educational Presentation

Educational Session Proposal

Name/credentials of Primary Speaker (list credentials per APTA standards ONLY):

Primary Speaker Email (all communications will occur with this speaker at this email):

Primary Speaker Phone Number:

Name/Credentials of 2nd Speaker (leave blank if only one speaker) Use APTA standards for credentials. (add additional speaker names and credentials below in the "Additional Speakers Biographies" section):

Email addresses of all other speakers:

Are you an APTA Member?

Are you an APTA NC Member/ If not a North Carolina member, but you are a member of another state, list in "other":

Title of Proposed Educational Session:

SHORT Title of Proposed Educational Session (will be used in marketing where long title will not fit. Less than 30 characters (including spaces):

Educational Session Proposal Description (100-150 words) Build a case for the need for the presentation, clearly state the purpose of the session, catch the attention of conference attendees, may include information about format, do not include table or graphs, no more than 150 words. *If your proposal is accepted this description will be used in promotional materials:

Why does the speaker feel this is a necessary topic for this conference? (this is information for the committee to better understand the need for the session):

Educational Session Proposal OBJECTIVES ("Upon completion of this educational session participants will be able to", Ensure there is a measurable performance verb in each objective, limit one verb per objective, presented in terms of what the learner will do, not the presenter, match the course description, choose objectives that are achievable for the group, time and structure of the course, give the attendees a clear example of what the session will cover):

Educational Session Proposal REFERENCES: Provide a minimum of 5 references that meet the following criteria: 2 are within the last 5 years, 5 within the last 10 years, at least 3 must be in peer reviewed journals, can provide more than 5 as long as 5 meet this criteria, MUST BE IN AMA FORMAT! THIS IS AN ABSOLUTE.

Primary Speaker BIOGRAPHICAL INFORMATION. This is your biography and will be offered in promotional and marketing material. Include name, credentials, institution, city, state, speaking experience, short bio to demonstrate expertise in topic (LIMIT 175 WORDS):

Secondary Speaker BIOGRAPHICAL INFORMATION. This is your biography and will be offered in promotional and marketing material. Include name, credentials, institution, city, state, speaking experience, short bio to demonstrate expertise in topic (LIMIT 175 WORDS):

Additional Speaker BIOGRAPHICAL INFORMATION (If applicable). This is your biography and will be offered in promotional and marketing material. Include name, credentials, institution, city, state, speaking experience, short bio to demonstrate expertise in topic (LIMIT 175 WORDS):

The APTA NC Annual Conference is looking to provide innovative and unique learning experiences. We would like to know about prior dissemination of this material. Has this material been taught previously? Please indicate when and where below to provide us with an understanding of familiarity with your specific course materials. Is it information presented in academic curriculum?, Other conferences? Recent or future webinars, presentations, DEU offerings, SIG presentations:

New Field:

Please state below which type of learner your information is geared toward? (multiple answers are acceptable, as long as it is supported above)

Student

Academic Faculty

Beginner (with this content - foundational review is included)

Intermediate (with this content - foundational review and application to cases and high level thinking)

Advanced (with this content - no foundational review, advanced critical thinking is encouraged)

Mixed Level (foundational knowledge as well as application and advanced critical thinking all in one course)

PTA

Other

Please explain how your content is appropriate for the level you indicated in the previous question. Include any knowledge a learner should have prior to participating in your presentation (if any):

CONFLICTS OF INTEREST: Please identify any conflicts of interest you may have related to this material or conference participation:

If applicable, identify any schedule limitations (educational sessions will be occuring throughout the day on Friday and Saturday):

Upload CV or resume

Upload File

Upload Headshot photo

Upload File