Workshop Proposal Form

www.therateltraininginstitute.org

Email: Info.therateltraining@gmail.com
Thanks for Working with Us.

Thank you for submitting your workshop proposal with Theratel Training Institute (TTI). We are excited for the opportunity to work with you. We appreciate you working with us to ensure life long learning for the social work community.

In submitting your workshop proposal you have the option of offering CEs to social workers, mental health counselors and marriage & family therapist professionals in New York State only. Theratel Training Institute will not be responsible for logistics of your workshop

Theratel Counseling Services/ Professional Development Collaborative (TCS/PDC) gives organizations, agencies, and individuals offering educational programming the opportunity to partner with Theratel Counseling Services an approved provider through the New York State Education Department (NYSED), to provide CEs during their own workshops, conferences and symposiums.

Applications must be complete and accurate before they are considered for review, including payment. Applications are considered complete once the CE Approval Team receives all the required application documents. Each workshop prooposal must be submitted and paid for separately. Application documents must be submitted as attachments via this form. Or you can email all items to Info.therateltraining@gmail.com. Links to application documents and materials are not accepted. Hand-written documents are not accepted.

Application Process & Review
- Complete a separate application form for each workshop.
- Application fee due upon reciept of invoice (non-refundable)
- Presenter(s) resume (resume must be submitted for each presenter)
- An outline & objectives of the presentation and any program content to support your submission (PowerPoint slides, lecture notes, etc.)
- You can also submit a full application with all required information from this form by email to Info.therateltraining@gmail.com
Reschedule or Cancellations: If for some reason you or TTI needs to reschedule or cancel a workshop, it must be done as soon as possible or within 1 week of the workshop date.

If you have any questions you can contact Amandia Speakes at 516-426-7970
Name

First NameLast Name
Email
example@example.com
Phone Number
Workshop Title
A working title for your workshop
Proposed Workshop Date/Time

MonthDayYear
Date
Hour MinutesAM/PM Option
Number of Contact Hours
(1) one continuing education hours = 50 minutes
Workshop Format

One timeMultiple sessions
Profession (select all that apply)

LMSWLCSWLMHCLMFT
Presentation Type

OnlineIn-PersonSelf-study (recorded presentation or course material with Post-test questions)Hybrid (combination of the above)
Areas of Practice (Check which best apply)

AddictionsTherapeutic interventionsCouples/RelationshipsEthicsGrief & LossMilitary/VeteransSchool Social WorkPrivate Practice/ClinicalSupervisionAgingSocial JusticeTraumaMental HealthHealth & HealthcareSocial work & spiritualityFamilies & childrenOther
The workshop must contribute to professional practice and have at least one NYSED approved topic areas identified below as its focus. Please check all that closely apply.

Theories & concepts of human behavior in the social environmentSocial work practice, knowledge, and skillsSocial work research, programs or practice evaluationsSocial work management, administration or social policySocial work ethicsClinical interventions, evidence-based models & principles of clinical social work, psychotherapy, & clinical social work diagnosisClient communications and recordkeepingAdministrative supervision of LMSW and clinical supervision of LCSW practicePedagogical metholodogies or other topics that contribute to the professional practice of LMSW or LCSW
Course Description
Provide a brief description (5-10 sentences) of your course content.
Please provide 3-5 learning objectives describing what participants will be able to do upon completion of the CE workshop. Click link for ideas on writing learning objectives, https://tips.uark.edu/using-blooms-taxonomy/
Self-Study Option ONLY: Submit 5 multiple-choice single answer post-test questions, along with a short reference list (2-3 references) for participants to access.
Presenters

Each presenter must provide name, credentials and cv/resume along with a short bio (5 to 10 sentences) and photo. Bio & photo will be used for marketing purposes. The cv/resume is documentation required by NYS Education Department.
Presenter 1: Name & Credentials
Presenter #1

Cancelof
Presenter 2: Name & Credentials
Presenter #2

Cancelof
Additional Notes for Theratel Training Institute

Provide any additional information that you would like for us to know.
Notes
any additional notes comments for the TTI Team

Application Fees - Pick One Only

Application Fee ( 30 days or more away)The workshop start date is more than 30 days from the date of CE review submission.

$250.00

Rush Application Fee (Less than 30 days away)The workshop start date is 29 days or less from the date of your CE review submission.

$350.00

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Credit Card

**Please note:** If the incorrect payment amount is selected based on your submission date, you will receive an invoice for the remaining balance.
Please verify that you are human*
Date Submitted

MonthDayYear
Date
Hour MinutesAM/PM Option
By clicking SUBMIT, I am stating that I understand and agree with all the information I have read and written as part of my workshop proposal submission.

Evaluation & Certificate Issuance Fees assessed after the start of the workshop

	Cost
1-50 Certificates - $9.00 per participant
51-100 - $8.00 per participant
100+ - $7.00 per participant

Should be Empty:

www.therateltraininginstitute.org

Presenters

Additional Notes for Theratel Training Institute

Credit Card