Culture Connections Presenter's Application Form

Family Connections: Culture Connections’ team is excited to invite professionals in the fields of mental and behavioral health and addiction recovery support to submit their proposals for our upcoming workshops. This is a unique opportunity to share your expertise and innovative approaches with a diverse audience, enhancing cultural competence and fostering positive cross-cultural relations. We look forward to receiving your submissions and collaborating to create impactful and engaging learning experiences.

1. First Name, Last Name *This question is required.

2. Telephone/Mobile Number *This question is required.

3. Email Address *This question is required. This question requires a valid email address.

4. Please share your social media links: (LinkedIn, Instagram, FaceBook, N/A, etc.) *This question is required.

5. Your Presenter's Title *This question is required.

6. Professional License Number or type N/A *This question is required.

7. Organization Name *This question is required.

8. Organization Telephone Number *This question is required.

9. Mailing Street Address *This question is required.

10. Mailing City, State and Zip Code *This question is required.

11. Speaker / Organization Website Address *This question is required.

12. Brief biographical sketch (100 words or less) *This question is required.

13. If you have presented before for Family Connections, please indicate when or type N/A: *This question is required.

14. Title of the proposed presentation (10 words or less) *This question is required.

15. Delivery of Presentation (Please select one) *This question is required.

16. Your Availability for Presentation Dates (If applicable, please share two consecutive dates) *This question is required.

17. Summary / description of presentation (100 words or less) *This question is required.

18. List three to five (3-5) learning objectives of your presentation that demonstrate action and measure (resource: https://www.aswb.org/wp-content/uploads/2018/09/ACE-Handbook-Acceptable-learning-objectives-list.pdf)

19. List, at minimum, five peer reviewed and/or evidence-based practice research references for your presentation (50% or five, whichever is less must be within the last five years): *This question is required.

20. Please list other organization events where you have presented and/or are scheduled to present, including the same title:

21. Please attach your updated resume and your photo. *This question is required.

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22. Please provide the name, organization, and phone number of two (2) references who can attest to the quality of your previous presentations: *This question is required.

23. In submitting this proposal, I certify that I understand if selected, I agree to abide by the deadlines and other conditions of presenting. I understand that my workshop presentation is not a showcase for promoting my business, practice, or product, and I will not sell my products or services from the speaker platform. I have read and understand the statement above. *This question is required.

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