Presenter Application Submission Form
The NHSSCA Executive Council and Unity Committee will review all presenter application submissions for inclusion. Incomplete applications will not be reviewed. If approved, you will be notified prior to the event.
Presenter Qualifications
You must be NHSSCA certified, or hold a four-year degree or higher. The NHSSCA Executive Council reserve the right to limit presenters in lieu of these qualification criteria on a case-by-case basis.
Which event are you submitting for?
*
Please Select
NatCon
State Clinic
Family Day
If Family Day or State Clinic is selected, please specify which state/region.
*
NatCon date and location is already scheduled and does not require you to specify state or region information. Newsletter date and location are NA.
Presenter's Full Name
*
First Name
Last Name
Presenter's Email
example@example.com
Presenter's Mobile Number
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Presenter's Headshot
Browse Files
Drag and drop files here
Choose a file
We only accept jpg, jpeg, png, and HEIF formatted picture files for upload. NOTE: 10 MB max file size.
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Please note: If you would like to have a Co-Presenter, please list their name below and ask them to complete a separate presenter application.
Co-Presenter's Full Name
Have you spoken at a previous NHSSCA event (Family Day, State Clinic, NatCon)? * If "yes," please continue to the next question.
*
Yes
No
When and where have you spoken at an NHSSCA event?
Credentials and Work Related Experience: Please Upload Your Resume
*
Browse Files
Drag and drop files here
Choose a file
We only accept pdf, doc, docx formatted files for upload. NOTE: 10 MB max file size.
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Please select the format of your presentation
*
Please Select
Lecture
Hands-on
Dual: Lecture
Dual: Hands-on
Length of presentation
*
Please Select
30 minutes
50 minutes
90 minutes
120 minutes
Newsletter500-700 words
Presentation Title
*
Presentation Description (200 word limit)
*
0/200
Learning Objectives/Outcomes
*
Please provide 2-3 bullet points
Submit
Should be Empty: