Pathways to Innovation Proposal Form
Presenting at Pathways to Innovation positions you as a change-maker in behavioral health and beyond. Share your insights and discoveries with your peers and advance the entire field towards better care for clients. Accreditation provided by TPN.health.
Educator Name and Credentials
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Preferred Phone Number
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Preferred Email Address
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Confirmation Email
Please enter twice for confirmation purposes.
Website
Educator Pronouns
Are you presenting on behalf of a treatment center, association, or other sponsoring organization? If yes, please list below:
If you are presenting on behalf of a partner, please provide the organization's contact to be included on communications.
Please provide full name and email address.
Brief Bio for each presenter (Please include relevant professional degree and discipline, current professional position, and expertise in workshop content.)
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Upload CV:
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Please upload a Curriculum Vitae (CV) or resume for each educator involved. The file name should be "Educator First Educator Last CV"
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Headshot
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Please upload a headshot for us to use in our marketing materials. The file name should be "Educator First Educator Last Headshot"
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Workshop Details:
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Have you presented this workshop before?
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Yes
No
Title of Presentation
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Topic(s)
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Please list any topic areas covered in your presentation.
What is the instructional level of this workshop?
Beginner
Intermediate
Advanced
What is the anticipated length of this workshop?
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Please Select
1 hour
1.25 hours
1.5 hours
1.75
2 hours
2.25 hours
2.5 hours
2.75
3 hours
> 3 hours
General Description of Presentation
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< 100 words overview of workshop.
Education Goals
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Educational goals reference overall professional growth, improved sophistication, or greater clinical skills, which would occur in future clinical work. They can be in paragraph form or listed as bullet points.
Measurable Learning Objectives
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At the end of this workshop, participants will be able to:
3+ measurable and observable learning objectives. Guidelines: https://drive.google.com/drive/u/1/folders/1LD15TkDlcik_IPFNismrrs96zgHChAUp, https://drive.google.com/drive/u/1/folders/1LD15TkDlcik_IPFNismrrs96zgHChAUp
Additional Workshop Materials:
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Please attach any workshop assets you have for us to review
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Slides, handouts, etc.
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Educators are required to disclose any potential conflicts of interest, commercial support, or commercial interest that applies to the content of the presentation. Are you accepting inducements or do you have any relationships that might affect this CE course? (note: answering "yes" does not necessarily preclude you from being an educator, these interests just must be disclosed to participants.)
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Yes
No
References
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3+ Peer-reviewed sources in APA format published in the past 10 years
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