Annual Ending Sexual Assault & Domestic Violence Conference
December 2014
Proposal Form
Conference Proposal Form
*** Attention: Resume or curriculum vitae for each presenter must be attached.
(Curriculum vitae/resume and bio are required for continuing education credit application.)
1 | Page
Annual Ending Sexual Assault & Domestic Violence Conference
December 2014
Proposal Form
It is anticipated that this conference will have approximately 500 registered participants from the following fields: power-based violence victim (child and adult) services (advocacy, treatment and education), law enforcement, nursing, disability, violence prevention, social welfare, batterer and sex offender treatment, social justice, criminal justice, legal, education, mental health, and government in the following focus areas: Human Trafficking, Disabilities, Substance Abuse,Primary Prevention/Social Change, Advanced Clinical/Mental Health, Non-Profit Administration, Children & Youth,Self Care, SART Issues, and Working with Marginalized Communities Including Male Victims.
1. Session Title(please limit to 50 characters):
2. Session Abstract (limit of 50 words): This will appear as written in the conference program. It should be written to accurately describe your session and attract participants.
3. How does the workshop relate to / intersect with sexual assault and/or domestic violence?:
4. Learning Objectives: Please list at least three (3) learning objectives. Identify new skills or knowledge the participant will have upon completion of the presentation. This is necessary to assure CE credit for workshop participants. Attach additional pages if necessary.
Objective 1:
Objective 2:
Objective 3:
5. To meet your learning objectives, what principles of adult learning and instructional systems do you plan to include with your presentation. Here is a website that describes the principles:
6. Preferred (not guaranteed) date for Session(Please write in the boxes 1, 2, and 3 for your more preferred dates to speak.):
Wed.December 10, 2014 / Thurs. December 11, 2014 / Fri. December 12, 20147. Session type: What type of session are you interested in?
Pre-Conference 90 Minute Workshop
Plenary Session 3 Hour Workshop
8. Categories(please choose the appropriate categories for your wkshp):
Sexual Assault Human Trafficking Intervention
Domestic Violence Stalking Prevention
Child Abuse All Both
Adults Molested As Children
9.Skill Level(Please indicate best audience for your presentation): Please be aware that the level may be changed by the planning committee.
Beginner – 1st year advocates with limited training/expertise in subject area
Intermediate – Experienced personnel with some general knowledge of the subject area
Advanced – Seasoned personnel with general experience in the subject area
All – program will provide basic overview and detailed skills practice to suit mixed audience
10. Audio/Visual Equipment(all workshops will be provided with a laptop, projector and 1 wireless mic). Please indicate additional needs:
Prefer to use own computer / Sound system (presentation includes audio or video) / Internet access (presentation requires access to internet)Other:
11. Draft presentation attached (PowerPoint or detailed outline): Credentialing boards require workshop information for continued education credit. Failure to submit this information may result in declination of the proposal.
YES
NO Explanation:
12. PLEASE NOTE: all handouts are provided to participants in electronic form at the start of the conference. If your workshop is accepted, you will be asked to submit all handouts in electronic form by November 1, 2014. If a handout is specifically used during the workshop and you need hardcopies to distribute, please advise:
This presentation includes handouts to be used during the workshop
This presentation includes supplemental handouts that are not used during the workshop
Both
13. Name(s) of Presenters:
- List the “organizer/lead presenter” first, this person will serve as a contact person for KASAP/KDVA and will be responsible for communicating with other presenters.
- Proposals must describe all presenters, including biographical sketch and must have CV/ resume attached for all presenters. Proposals that do not include bio and CV/resume, 2 documents, for all presenters are considered incomplete and may not be considered.
- All presenters must be in attendance at the presentation.
- If more than 3 presenters, please attach additional page to proposal.
Organizer/Lead Presenter:
Name: / Credentials (ex. BA, MSW, PhD):Job Title: / Organization/Agency:
Address:
City, State, Zip / Phone:
Fax: / E-mail:
Brief Biographical Sketch (Bio): Limit: Three (3) typewritten lines (as it should appear in conference materials and CEU applications).
CV or resume for Organizer/Lead Presenter is attached.
I have the following needs:
Mobility Assist. / ASL Interpreter / Large Print / OtherSignature of Lead Presenter ______Date ______
(Not required if submitted electronically)
Presenter #2:
Name: / Credentials (ex. BA, MSW, PhD):Job Title: / Organization/Agency:
Address:
City, State, Zip / Phone:
Fax: / E-mail:
Brief Biographical Sketch (Bio): Limit: Three (3) typewritten lines (as it should appear in conference materials and CEU applications).
CV or resume for Presenter #2 is attached.
I have the following needs:
Mobility Assist. / ASL Interpreter / Large Print / OtherPresenter #3:
Name: / Credentials (ex. BA, MSW, PhD):Job Title: / Organization/Agency:
Address:
City, State, Zip / Phone:
Fax: / E-mail:
Brief Biographical Sketch (Bio): Limit: Three (3) typewritten lines (as it should appear in conference materials and CEU applications).
CV or resume for Presenter #3 is attached.
I have the following needs:
Mobility Assist. / ASL Interpreter / Large Print / Other1 | Page