Presentation Proposal Application - 2025 MPA ANNUAL CONFERENCE

Presentation Proposal Application for the 89th MPA Annual Conference - April 24-25, 2025

The MPA Annual Conference Committee is accepting proposals for presentations for the 89th Annual MPA Conference. Please complete this form if you are interested in or have been invited to present at the conference. Proposals from MPA members and nonmembers alike are welcome.
Name of Person Submitting Information (INFORMATION ON ALL SPEAKERS WILL BE ENTERED BELOW)*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Please read below paragraph and initial to acknowledge.
MPA is approved by the American Psychological Association to sponsor continuing education for psychologists. MPA maintains responsibility for its programs and their content. Each section of information in the proposal form is required. By providing a copy of this information to MPA and initialing below, you acknowledge you comply with APA Ethical Principles of Psychologists

(see http://www.apa.org/ethics/code2002.html.)
Initials*

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Program/Session Title*
Up to 15 words
Program Description (Up to 500 words) for attendees to be used for marketing purposes. Please explain clearly.*

Up to 500 words0/500
List of Learning Objectives: Use the following guideline in determining the minimum number of Learning Objectives (LO) you should write based on the length of your proposed program: • 2 or more learning objectives for one hour of presenting • 3 or more learning objectives for two hours of presenting. Begin each LO with an active verb such as apply, demonstrate, analyze, recognize, explain, list, describe, compare. Friendly hint: Avoid verbs such as understand, learn, and appreciate.*
All learning objectives should correlate with the program description.
The program will fulfill the following criterion based on APA Curriculum Content Standard (please check one):*

Program content focuses on application of psychological assessment and/or intervention methods having overall consistent and credible empirical support in the contemporary peer reviewed scientific literature beyond those publications devoted primarily to promoting the approach.Program content focuses on ethical, legal, statutory or regulatory policies, guidelines, and standards that impact psychological practice, education, or research.Program content focuses on topics related to psychological practice, education, or research other than application of psychological assessment and/or intervention methods that are supported by contemporary scholarship grounded in established research procedures.
Provide at least three (3) current (e.g., within the past 10 years), relevant, peer-reviewed references in APA-style citation, which support the evidence-base for the content covered in this proposed program.*
The content of this presentation is at the following level:*

Introductory: Assumes post-doctoral education status and limited familiarity with topic.Intermediate: Assumes post-doctoral education status and general familiarity with topic.Advanced: Assumes post-doctoral education status and some specialized knowledge of topic.
Length of Program*

FlexibleOne (1) hourTwo (2) hours
Do you give MPA permission to record this session? This session may or may not be used for distance learning.*

YesNo
Name of Presenter #1*

First NameLast Name
Spell your name phonetically
Email*
example@example.com
Address where honorarium should be mailed after the conference.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Are you licensed?*

YesNo
Please list your licensure(s)*
Up to 15 words
MPA Membership Status*

MemberNon MemberDon't Know
Please list your: 1. Highest Degree, 2. Degree Area, and 3. Institution. Please note, if you are a student, list contact information for your faculty advisor or faculty member who supervised your work.*
Current Primary Affiliation and Position:*
Brief bio to be used for publication purposes. Please tailor your bio to show your expertise in the presenting topic. (125 words):*

125 words0/125
Conflict of Interest Disclosure: A conflict of interest reflects a relationship with any entity producing goods or services related to the topic such as having a book in-print, stock ownership, or board membership. Pick one:*

I have no potential conflicts of interest to reportI have the following potential conflicts of interest (list all from past 12 months)
Describe the conflict of interest, what was received, and for what role:
125 words
Attach a resume or CV for Presenter #1.*

Cancelof
Attach a headshot image of Presenter #1.*

Cancelof
Is there another Presenter? (Information from all speakers must be entered into this form. If no other presenters, scroll down and click on "Agreement and Signatures.")*

YesNo

Presenter #2 Information
Name of Presenter #2

First NameLast Name
Spell your name phonetically
Email
example@example.com
Address where honorarium should be mailed after the conference.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Are you licensed?

YesNo
Please list your licensure(s)
Up to 15 words
MPA Membership Status

MemberNon MemberNone
Please list your: 1. Highest Degree, 2. Degree Area, and 3. Institution. Please note, if you are a student, list contact information for your faculty advisor or faculty member who supervised your work.
Current Primary Affiliation and Position:
Brief bio to be used for publication purposes. Please tailor your bio to show your expertise in the presenting topic. (125 words):

125 words0/125
Conflict of Interest Disclosure: A conflict of interest reflects a relationship with any entity producing goods or services related to the topic such as having a book in-print, stock ownership, or board membership. Pick one:

I have no potential conflicts of interest to reportI have the following potential conflicts of interest (list all from past 12 months)
Describe the conflict of interest, what was received, and for what role:
125 words
Attach a resume or CV for Presenter #2.

Cancelof
Attach a headshot image of Presenter #2.

Cancelof
Is there another Presenter?

YesNo

Presenter #3 Information
Name of Presenter #3

First NameLast Name
Spell your name phonetically
Email
example@example.com
Address where honorarium should be mailed after the conference.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Are you licensed?

YesNo
Please list your licensure(s)
Up to 15 words
MPA Membership Status

MemberNon MemberNone
Please list your: 1. Highest Degree, 2. Degree Area, and 3. Institution. Please note, if you are a student, list contact information for your faculty advisor or faculty member who supervised your work.
Current Primary Affiliation and Position:
Brief bio to be used for publication purposes. Please tailor your bio to show your expertise in the presenting topic. (125 words):

125 words0/125
Conflict of Interest Disclosure: A conflict of interest reflects a relationship with any entity producing goods or services related to the topic such as having a book in-print, stock ownership, or board membership. Pick one:

I have no potential conflicts of interest to reportI have the following potential conflicts of interest (list all from past 12 months)
Describe the conflict of interest, what was received, and for what role:
125 words
Attach a resume or CV for Presenter #3.

Cancelof
Attach a headshot image of Presenter #3.

Cancelof
Is there another Presenter?

YesNo

Presenter #4 Information
Name of Presenter #4

First NameLast Name
Spell your name phonetically
Email
example@example.com
Address where honorarium should be mailed after the conference.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Are you licensed?

YesNo
Please list your licensure(s)
Up to 15 words
MPA Membership Status

MemberNon MemberNone
Please list your: 1. Highest Degree, 2. Degree Area, and 3. Institution. Please note, if you are a student, list contact information for your faculty advisor or faculty member who supervised your work.
Current Primary Affiliation and Position:
Brief bio to be used for publication purposes. Please tailor your bio to show your expertise in the presenting topic. (125 words):

125 words0/125
Conflict of Interest Disclosure: A conflict of interest reflects a relationship with any entity producing goods or services related to the topic such as having a book in-print, stock ownership, or board membership. Pick one:

I have no potential conflicts of interest to reportI have the following potential conflicts of interest (list all from past 12 months)
Describe the conflict of interest, what was received, and for what role:
125 words
Attach a resume or CV for Presenter #4.

Cancelof
Attach a headshot image of Presenter #4.

Cancelof

Agreement and Signatures - REQUIRED TO SUBMIT
AGREEMENT FOR ELECTRONIC RECORDING AND USE OF CONTINUING EDUCATION PROGRAM CONTENT

This AGREEMENT FOR ELECTRONIC RECORDING AND USE OF CONTINUING EDUCATION PROGRAM CONTENT (“the Agreement”) is made as of the date of signature below. This agreement is written in compliance with MPA's Antitrust and Conflict of Interest policies.For good and valuable consideration, the receipt of which is hereby acknowledged, the undersigned who is the author and presenter of a Continuing Education Program “Presenter” hereby irrevocably grants to the Minnesota Psychological Association (MPA) and its agents (together, the "MPA"):
1. The right to photograph, record, tape, or otherwise reproduce in any manner the Presenter’s continuing education presentation content ("the Product"), entitled:

2. The right hereafter to use his/her appearance, likeness, voice, approved biography and name (but no other personal data) in context (i.e., in a manner that, in the exercise of normal good faith and judgment, does not misrepresent, distort, caricature or ridicule him or her) solely in connection with the exploitation of the Product in all forms and media throughout the world, including, but not limited to, internet broadcast, video files) and all other ancillary or derivative rights in the Product (including, without limitation, print publication, merchandising, and sound recordings); and

3. The right hereafter to use his/her appearance, likeness, voice and name (but no other personal data) in any way MPA deems appropriate, for any advertising, publicity, or promotional use or purpose solely in connection with the Product, but subject to the limitation to in-context use more fully described in the preceding paragraph.
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The undersigned allows MPA to keep the product in its Online CE Library until it opts to remove it.
Print Name
The undersigned represents that he/she/they is over 18 years of age, that he/she/they has read this Release and fully understands the meaning and effect of this Release, and that he/she/they, intending to be legally bound, has signed this release. *

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The speaker(s)/presenter(s) of this presentation believe in good faith that their content and materials constitute Fair Use as per Copyright Act of 1976, Title 17 United States Copyright Section 107. Speaker(s)/Presenter(s) understand that permission from the copyright owner should be obtained if the content and materials go beyond Fair Use. *

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I have read the foregoing, understand its terms and stipulations and agree with them all. Print Name:*
Print Name
Electronic Signature Agreement. By selecting the "I Accept" button, you are signing this Agreement electronically.*

I Accept
Should be Empty:

Presentation Proposal Application for the 89th MPA Annual Conference - April 24-25, 2025

Please read below paragraph and initial to acknowledge.

AGREEMENT FOR ELECTRONIC RECORDING AND USE OF CONTINUING EDUCATION PROGRAM CONTENT