Call for Programs Submission Form

Presentation Title*

Presentation Length*

90 minutes
3 hours
Full day (6 hours)

Number of Presenters*

Single Presenter
Multiple Presenters
Panel Discussion

Intended Audience*

Beginner: 80% of your presentation is background, research, or theory-based information with some application, intended for participants new to this topic. Intermediate: 50% of your presentation is background, research, or theory-based information and 50% application, intended for participants familiar with and have some experience in this topic. Advanced: Your presentation is 80+% application, intended for participants with background knowledge and experience in this topic.

Beginner
Intermediate
Advanced

Program Abstract / Overview (600 words or less)*

Learning Objectives*

Learning Objectives: Define objectives you intend the audience to achieve by the end of your presentation. For information on writing learning objectives see: https://www.nbcc.org/Assets/CeProvider/ACEPLearningObjectives.pdf

Powerpoint?*

Will you allow IMHCA to make your Powerpoint available to conference attendees on our website?

Yes, before the conference
Yes, but only after the conference
No

Handouts/Materials*

Please describe any handouts or materials you will be distributing during your presentation

Presentation Needs*

Please indicate all the items you will need for your presentation

Laptop/Computer
Projector
Lavalier microphone
Handheld microphone
Podium
Flipchart with markers

Do you plan to show a movie or video during your presentation?*

Yes
No

Additional Needs for your presentation

Primary Presenter

Please complete for the Primary Presenter. The IMHCA Conference Team will communicate with this person.

Name*

First Last

Degree (Ph.D., MA, MS, etc.)*

Credentials (LISW, LMHC, etc.)*

Email*

Phone*

Primary Presenter Bio (50 word maximum)*

Plans for Conference Attendance*

Just my presentation
Just the day of my presentation
The entire conference (two days)
Unsure at this time

How many co-presenters do you have?*

Zero
One
Two
Three

Co-presenter 1

Name*

First Last

Degree (Ph.D., MA, MS, etc.)*

Credentials (LISW, LMHC, etc.)*

Email*

Phone*

Co-Presenter 1 Bio (50 word maximum)*

Plans for Conference Attendance for Co-presenter 1*

Just my presentation
Just the day of my presentation
The entire conference (two days)
Unsure at this time

Co-presenter 2

Name*

First Last

Degree (Ph.D., MA, MS, etc.)*

Credentials (LISW, LMHC, etc.)*

Email*

Phone*

Co-Presenter 2 Bio (50 word maximum)*

Plans for Conference Attendance for Co-presenter 2*

Just my presentation
Just the day of my presentation
The entire conference (two days)
Unsure at this time

Co-presenter 3

Name*

First Last

Degree (Ph.D., MA, MS, etc.)*

Credentials (LISW, LMHC, etc.)*

Email*

Phone*

Co-Presenter 3 Bio (50 word maximum)*

Plans for Conference Attendance for Co-presenter 3*

Just my presentation
Just the day of my presentation
The entire conference (two days)
Unsure at this time

Call for Programs Submission Form

2021 Conference Call for Programs

Call for Programs IMHCA Conference

Primary Presenter

Co-presenter 1

Co-presenter 2

Co-presenter 3