ISHN 2022 Proposals - Covering Kids & Families of Indiana

ISHN Proposal Application

2022 INDIANA SCHOOL HEALTH NETWORK CONFERENCE
CALL FOR PROPOSAL APPLICATION

SUBMISSION DEADLINE: JANUARY 15, 2022
Please complete application fully. All information is to be written as it should appear in the conference and marketing materials should your proposal be selected.

Primary Contact Information

To be completed by the individual submitting the application and coordinating with the presenter(s).

Primary Contact Name *

Organization *

Address *

Address

Address

Address

City
City

State/Province
State/Province

ZIP/Postal
ZIP/Postal

Email *

Phone *

Presentation Overview

Title (10 word maximum) *
10 word maximum

Abstract/Summary (150 word maximum) *

Learning Objectives

A minimum of three (3) Learning Objectives are required. Learning objectives must indicate a demonstrable skill or knowledge to be acquired.

Objective 1

Objective 2

Objective 3

Additional Objectives

Presenter Information

Complete the following for all presenters, panel participants, or facilitators who will be assisting with the presentation. Submit additional documents as needed.

Number of Presenters *

Presenter 1

Name *

Organization *

Credentials *

Address

Address

Address

Address

City
City

State/Province
State/Province

Zip/Postal
Zip/Postal

Country
Country

Email *

Phone *

Biography (100 word maximum) *

Headshot

Maximum file size: 52.43MB

Social Media

Website

Twitter

Facebook

LinkedIn

Presenter 2

Name *

Organization *

Credentials *

Address

Address

Address

Address

City
City

State/Province
State/Province

Zip/Postal
Zip/Postal

Country
Country

Email *

Phone *

Biography (100 word maximum) *

Headshot

Maximum file size: 52.43MB

Social Media

Website

Twitter

Facebook

LinkedIn

Presenter 3

Name *

Organization *

Credentials *

Address

Address

Address

Address

City
City

State/Province
State/Province

Zip/Postal
Zip/Postal

Country
Country

Email *

Phone *

Biography (100 word maximum) *

Headshot

Maximum file size: 52.43MB

Social Media

Website

Twitter

Facebook

LinkedIn

Presenter 4

Name *

Organization *

Credentials *

Address

Address

Address

Address

City
City

State/Province
State/Province

Zip/Postal
Zip/Postal

Country
Country

Email *

Phone *

Biography (100 word maximum) *

Headshot

Maximum file size: 52.43MB

Social Media

Website

Twitter

Facebook

LinkedIn

Presenter 5

Name *

Organization *

Credentials *

Address

Address

Address

Address

City
City

State/Province
State/Province

Zip/Postal
Zip/Postal

Country
Country

Email *

Phone *

Biography (100 word maximum) *

Headshot

Maximum file size: 52.43MB

Social Media

Website

Twitter

Facebook

LinkedIn

Presenter 6

Name *

Organization *

Credentials *

Address

Address

Address

Address

City
City

State/Province
State/Province

Zip/Postal
Zip/Postal

Country
Country

Email *

Phone *

Biography (100 word maximum) *

Headshot

Maximum file size: 52.43MB

Social Media

Website

Twitter

Facebook

LinkedIn

Audio / Visual

All PowerPoint presentations and handouts must be submitted no later than May 31, 2022.

Additionally, please bring your presentation loaded on a USB drive for use during the session.

A laptop, projector, screen and podium will be provided. Breakout rooms seat approximately 50-75 people yet are small enough that no microphone should be needed.

If your presentation has sound, please request external speakers in your list of A/V requirements.

List A/V Requirements

Continuing Education (CE) Documentation

If your proposal is selected, you will receive additional documentation which must be completed and returned in a timely manner for your session to be included in the CE application. Information typically included in the CE documentation includes:

Course agenda

Target audience

Teaching methods

Reference/Resource list

Initial to acknowledge *

Additional Comments
Please use the space above for additional comments, questions or concerns not addressed in the application.