Application to Present a Workshop

Expand each section below by clicking the link in each heading and completing the required section

(licensed professionals you want to attend):
Below are suggestions (please enter all that apply and add others if needed)
Psychologists, Psychoanalysts, Psychiatrists (←only partial credit for MDs via APA), Social Workers, MFTs, Counselors, Substance Abuse Counselors, Occupational Therapists, Nurses, Dentists

Please list the pricing for your event (indicating discounts for groups, and students/interns, and web registration) – If you need a discount code for a special group (please let us know on the front end)

A paragraph or two describing the session and what you will cover.

Attach a detailed description of what you will do during the time allotted.
Please indicate time for all segments, including breaks and meals.
9:00-10:30 Comparisons of co-morbid diagnosis treatment options that work
10:30-10:45 Break
10:45-12:00 Chemical Dependency
Eating Disorders
Self-Injurious Behaviors ….(etc.)

List 3 learning objectives for every 4 hours of content. Format as what participants will be able to DO after the session, not what the presenter intends to COVER during the session.

Include – name, mailing address (street, city, state, zip and country if outside US), day and evening phone numbers, email. Also include degrees, professional license numbers, expiration dates, and states where they are valid. End with current job description (one sentence).

John Smith
Licensed Psychologist, #043-005630, GA – Expires 10-31-03
1443 Euclid St SW
Starke, FL 32237
909-123-4567 (d)
909-987-6543 (e)
Job Description: Associate Professor, ABC University, Psychology Department

Copy and paste the text from the presenter's resume, to include: education, training, degrees, major area(s) of study, institution(s) from which degree(s) were received, and year(s) received: publications, presentations, and any pertinent experience that qualifies the presenter on the topic to be presented.

Provide a minimum of 5 resources for a 6 CE hour course. More for a longer course. (current: culled from within the last five years) used to research the topic and/or for further reading by the attendee. Please do not include more than one source authored by the presenter. Please submit in correct bibliographic format. Sources must be within the last 5 years. These must be from peer reviewed scientific journals

Please tell us how you intend to promote the course. (Also, please indicate your website address below).

(Example: Media, PowerPoint, Handouts, Small Group, Q&A, Didactic Lecture, Vicdeo Role Play, Live Demonstration)