Pre-Congress Workshop Application


Section I - Workshop Information

Pre-Congress Workshop Title.*
Session titles should be entered in title case and may not exceed 150 characters.
Proposed Content Area:*
Secondary Content Area (not required):
Purpose (one sentence):*
The purpose of the workshop is...
Description (300 words or less):*
If the session is accepted into the program, the overview will be published in congress materials to help attendees select which session they would like to attend.
Educational Design/Outline
Please complete the objective fields below. Each application must provide three comprehensive objectives which include: the explicit objective, content, time frame, faculty, and teaching/learning strategies.

Objective 1
Objective:*
List each educational objective/outcome for this workshop.
Upon completion, the learner should be able to...
Content (Topics):*
Provide content/topics presented which correspond to each objective.
Time Frame:*
Give a time frame for each content area.
Faculty:*
List the person presenting each topic/content area.
Teaching/Learning Strategies:*
Format, Teaching Strategies, Learning Strategies, Materials, Resources, Delivery Methods, Learner Feedback.

Objective 2
Objective:*
List each educational objective/outcome for this workshop.
Upon completion, the learner should be able to...
Content (Topics):*
Provide content/topics presented which correspond to each objective.
Time Frame:*
Give a time frame for each content area.
Faculty:*
List the person presenting each topic/content area.
Teaching/Learning Strategies:*
Format, Teaching Strategies, Learning Strategies, Materials, Resources, Delivery Methods, Learner Feedback.

Objective 3
Objective:*
List each educational objective/outcome for this workshop.
Upon completion, the learner should be able to...
Content (Topics):*
Provide content/topics presented which correspond to each objective.
Time Frame:*
Give a time frame for each content area.
Faculty:*
List the person presenting each topic/content area.
Teaching/Learning Strategies:*
Format, Teaching Strategies, Learning Strategies, Materials, Resources, Delivery Methods, Learner Feedback.



Will you be making clinical recommendations during your presentation?*
How does this workshop fit the Congress theme of Advancing Healthcare Together: Inclusive. Informed. Integrative. (250 words or less)?:*
Proposed length of workshop:*
Preferred room setup (Click here to view the room sets):*
While every effort will be made to accommodate these requests, the setup is not guaranteed and will the final setup will be communicated to accepted submitters.
Other Setup/Session Details:
Please include budget needs, if applicable.
Who is the target audience of the workshop? Are there particular skills or background that are recommended as pre-requests? (limit to one to two sentences):*
Is this workshop proposed by an organization?*
Has the content (or substantial parts) of this workshop been previously presented or published? NOTE: Previous experience presenting the material may be considered a strength as long as continued interest is anticipated.*

Section II - SUBMITTER INFORMATION

Primary Presenter (Contact Person and Organizer)
This person will be receiving all conference-related communications.

First Name:*
Last Name:*
Brief relevant background (1-2 sentences):*
Position / Professional Title:*
Trainee?*
Organization:*
City:*
State/PV:
Country:*
Work Telephone:*
Include full number, including county code, if outside the U.S.
Mobile:
Add As Presenter

Presenter(s)

Presenter 1
First Name:*
Last Name:*
Brief relevant background (1-2 sentences):*
Position / Title:*
Trainee?*
Organization:*
City:*
State/PV:*
Country:*
Work Telephone:*
Mobile:*
Photo/Headshot:*