• Presenter Name(s)

• Presenter Address(es)

• Email(s)

• Phone

• Presenter(s) license

• Please provide a brief Bio (no longer than 4 lines of text) that will be used in advertising

• Presenter Résumé (to be Uploaded)

COURSE OVERVIEW

• • Course Title

  • Abstract/Course Outline (Should be 1-2 paragraphs)

  • Course Length

  • Agenda

This outline should display a course breakdown with a timed schedule of the day's event(s). It must include individual course segments, guided discussion, and activities, where applicable.

Resources for further study:

• List at least 3 current (within the past 10 years), relevant (aligned with learning objectives and content), supporting (e.g., peer- review journal articles), and complete references (in APA format) as evidence that program content has met the requirements for APA standards. Books may be used in addition to peer reviewed journals/periodicals. This is a required field for APA Credits. Please note that research cited in the references must have clear linkage between program content. For example, simply listing a journal article on a broad or related issue is unacceptable until and unless the applicant specifically documents how the referenced research is relevant to the specific program content. It is not acceptable to assert that the program content has been included in peer-reviewed publications without providing specific references that are currently available to reviewers and support that assertion. If included references are authored or co-authored by the session presenter(s), please be sure to note this as a potential conflict of interest later in this application.

• Please include at least five references (or 50%, whichever is less) that were published within the past five years. Please use APA format.

This workshop is geared to the clinician at the following levels:

• Beginner

• Intermediate

• Advanced

• Please select the course level

COURSE OBJECTIVES

List specific, clear and concise learning objectives and/or outcomes for the course that are both behavioral and measurable.

(Course learning objectives need to be measurable and/or observable. They should state what a participant will be able to demonstrate immediately after attending the course. To "understand" or "have familiarity with" something is not measurable or observable. Verbs like "describe, name, explain, define, recall, list, restate, role-play, summarize, and write" are the most common used to describe what the attendee will actually be able to demonstrate after attending the training.)

• Objective 1

• Objective 2

• Objective 3

• DIVERSITY

  • Please provide previous experience of addressing diversity as well as your plan for doing so in regard to this proposal.

QUIZ (FOR ONLINE WEBINARS ONLY)

Workshops and In-Person Trainings Do Not Require a Quiz

Please upload your multiple choice quiz in a Word document. A minimum of 6 questions per hour of presentation time is required, with 5 choices for each question and only 1 possible correct answer. Please Bold your correct answer within the Word document.

SAMPLE PRESENTATION

Upload a video or include a link to a previous/sample presentation.

CONFLICT OF INTEREST DISCLOSURE FORM

• I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this section or publication.

• I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this section or publication. I must disclose this information to the public who attend my presentation or read my publication. Below are the financial interest/arrangement or affiliation as well as the nature of the relationship, e.g. research grants, employment, consulting fees, ownership or partnership, stock, and other remuneration, such as honoraria and travel expenses.

INSTRUCTOR COMMITMENT

By agreeing to present a continuing education activity, presenters commit to the following:

• Presenters should be familiar with the ethical principles established in the American Psychological Association's Ethical Principles for Psychologists, a copy of which will be furnished upon request.

• Presenters must respect the need for privacy and confidentiality throughout the program and assume responsibility for reminding participants of this, as needed.

• Presenters must anticipate the possibility of stress related to program content and to allow time for participants to process these feelings should the need arise.

• Presenters will offer information on the scientific or professional basis of the content presented. This is to include the validity and utility of the content and associated materials, the basis of such statements about validity/utility, and the limitations of and risks (severe and most common) associated with the content, if any. This can be done through references that support the content from the scientific or professional literature and/or through the program learning objectives and/or verbally during the activity.

• Presenters must disclose any commercial support (for the program, presenter, or product reviewed) and any other relationship that could reasonably be construed as a conflict of interest.