13Th Annual Case Management Conference

18th Annual Pennsylvania Case Management Conference (MC04)

June 18, 2010

Robert Morris University

Moon Township, PA

*** Email/electronic submissions strongly encouraged. Please email completed form and proposal in a word attachment to . Additional copies can be found on our website http://www.wpic.pitt.edu/oerp/cmconf/.

Primary Presenter

Title of Program:
First Name: / Last Name:
Degree(s) and Certifications (e.g. MSW; CAC)
Institutional Affiliation:
Title:
Address:
Address 2:
City: / State: / Zip or Country Code:
Day Telephone:
E-Mail Address:

*Note: The primary presenter will receive all correspondence and will be responsible for communicating all information to all co-presenters. Please attach copies of a resume/CV or a brief biographical sketch for all the presenters. Please note that only the primary presenter receives complimentary tuition to the conference. All co-presenters are required to register for the conference and pay the conference registration fee.

Co – Presenter #1

First Name: / Last Name:
Degree(s) and Certifications (e.g. MSW; CAC)
Institutional Affiliation:
Title:
Address:
Address 2:
City: / State: / Zip or Country Code:
Day Telephone:
E-Mail Address:

Co – Presenter #2

First Name: / Last Name:
Degree(s) and Certifications (e.g. MSW; CAC)
Institutional Affiliation:
Title:
Address:
Address 2:
City: / State: / Zip or Country Code:
Day Telephone:
E-Mail Address:

All workshops are 1.5 hours in length:

Please check the appropriate target audience:

c Case Manager c Supervisor c Consumer

c Administrator c Family Member c Peer Specialist

c Other______

Proposal:

1.  Program Description: On a separate sheet or attached to this form, please provide a short program description/abstract (50-75 words). Please feel free to provide documentation to support your proposal such as journal articles or cited research.

2.  Educational Objectives: Please include three (3) educational objectives with your proposal. Proposals without educational objectives cannot be considered. When formulating educational objectives, do not use verbs that are open to multiple interpretations such as learn, know, tell, understand, enjoy, appreciate, believe and perceive. Please use verbs that are observable, active, and measurable when formulating educational objectives. Examples of appropriate verbs include: analyze, design, describe, utilize and recognize.

Please check the appropriate focus (select one):

c Common Ground in Providing Mental Health Services

c Psychiatrist/Consumer Partnerships

c Single Point of Accountability

c Social Inclusion

c Co morbidity with Medical Illness

c Housing

c Spirituality

c Other (please identify) ______

Please mail, fax or email proposals by November 13, 2009 to:

Joanne Slappo, PhD, CPRP, CRC WPIC/OERP, Room 163 4601 Baum Blvd, WPIC, 3811 O’Hara St, Pittsburgh, PA 15213; fax: 412-802-6910; email: .