NOAH 2020 Conference Interactive Arts Activity Proposal Form

Interactive Arts Activity Proposal

2020 Conference
Contact Information
Proposal Contact Name:

First Name Last Name
Contact Company:
Contact Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Contact Phone Number:

Area Code Phone Number
Contact Mobile Number:

Area Code Phone Number
E-mail:
Facilitator Information
Name:

First Name Last Name
Company:
Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number:

Area Code Phone Number
In what type of Organization do you work?

Design/Architecture Community Arts Organization Performing Arts Organization Public Health Organization University Artist Hospital/Specialty Medical Center Medical Office/Clinic/Outpatient Center University Medical School Long Term Care Facility/Community
Facilitator Bio For Printed/Online Program:

0/1000
Facilitator Headshot for Online Program:

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Where have you presented in the last 2 years?:

0/500
Please provide a link to any online video featuring the proposed speaker:
Additional Facilitators
Facilitator #2 Bio for Printed/Online Program:

0/1000
Facilitator #2 Headshot for Online Program

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Facilitator #3 Bio for Printed/Online Program:

0/1000
Facilitator #3 Headshot for Online Program

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Facilitator #4 Bio for Printed/Online Program:

0/1000
Facilitator #4 Headshot for Online Program

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Diversity and Inclusion Information
Applicants are encouraged to share if they identify with one or more historically marginalized groups (examples include but are not limited to Immigrant, Indigenous, International, LGBTQIA, Person of Color, Person with Disability, Person of Size, Socioeconomic Disadvantage).
Accessibility Information
With NOAH's encouragement to apply for a conference scholarship if financial assistance is needed, are there any further accommodations that can be made for presenter(s) that would eliminate barriers to participation?
Proposed Activity Information
Proposed Activity Title:

0/500
Proposed Activity Description:

0/500
Learning Objectives

Include 3 learning objectives your activity will cover. These bullet points should outline benefits for an attendee in this session. A clear connection between the conference theme and the activity must be made.
1.

0/150
2.

0/150
3.

0/150
List the specific Code or Standard from NOAH's Code of Ethics and Standards for Arts in Health Professionals that applies to your activity:
Facilitators must bring their own supplies and NOAH is unable to reimburse for these items. Provide a supply list for this activity, with an ideal estimated number of participants.
Provide image(s), if applicable, of completed activity.

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This activity is geared towards:

Arts in Health Program Administrators Artists in Healthcare and Wellness Settings Academic Professionals/Students Healthcare Professionals Healthcare Administrators Architects & Designers Art Consultants Interior Designers
To get the most benefit from your activity, attendees should:

Be early careerists or new to this subject area Have a working knowledge of the subject area Have extensive experience in the subject area
Preferred Day for Activity:

Tuesday, September 22 Wednesday, September 23 Thursday, September 24
Other Submission Comments?

0/500
Should be Empty:

Interactive Arts Activity Proposal

Contact Information

Facilitator Information

Additional Facilitators

Diversity and Inclusion Information

Accessibility Information

Proposed Activity Information