PRESENTATION APPLICATION

Collaboration and Innovation: A Formula for Success

2017 NJAMHAA Annual Conference

APPLICATION DEADLINE: OCTOBER 21, 2016

March 29 – 30, 2017, Renaissance Woodbridge Hotel

•  Complete this form in the way you want the information to appear on all conference materials.

•  ALL fields are required in order to be eligible for Continuing Education Units (CEUs).

•  Submit this completed form as a Word document with your CV/resume and professional photograph to .

•  All proposals with supporting documents must be submitted by October 21, 2016.

SESSION TITLE:

(Has this presentation been previously approved for CEUs? Yes ______No ______

If yes: Certifying Organization ______Date Approved ______Number of CEUs ____ )

PRESENTER:

Full Name: Credentials:

Title:

Organization Name and Address:

Email Address:

Office Phone: Fax:

Social Work license #: (if not applicable, please put NA)

NASW member Id(s): (if not applicable, please put NA)

Website, Twitter and/or Social Media links: (if applicable)

BRIEF BIOGRAPHY:

CO-PRESENTERS: Each session may have up to 3 presenters. Please provide the information listed above for each co-presenter on separate form.

SESSION INFORMATION:

Target Audience: (e.g. Social Workers, Counselors, Management, Fiscal, etc. – specify all that apply)

Audience Target Levels: (Please specify all that apply)

____ Beginner _____ Intermediate ____ Advanced

APPLICATION DEADLINE: OCTOBER 21, 2016

March 29 – 30, 2017, Renaissance Woodbridge Hotel

WORKSHOP DESCRIPTION:

LEARNING OBJECTIVES:

·  A minimum of three (3) learning objectives is required.

·  Each learning objective needs to be framed using a measurable and/or observable verb like: define, describe, name, explain, list. Stay away from vague verbs like learn and understand.

·  Each learning objective should be brief.

At the end of this session, attendees will be able to:

1.

2.

3.

Indicate the type of credits this session is appropriate for:

___Clinical ___Non-clinical ___Ethics ____Social and Cultural Competence

COURSE CONTENT: Provide an outline that identifies your discussion topics and any planned activities. You should be able to easily compile a list from your course description and objectives.

BIBLIOGRAPHY: List a minimum of three (3) references (five or more is preferable) as evidence of supporting research (bibliography). This is a required field in order to offer CEUs. Bibliography must be in APA format and at least half of the references must be from within the last 5 years.

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