2025 SECHW and KYACHW Conference Speaker Information Request Form

The Southeast CHW Network are excited to be co-hosting this year's annual conference with the Kentucky Association of Community Health Workers in Lexington, KY on September 18th & 19th.

Oral Presentation applications are now closed.

Poster Presentations submissions will be accepted till June 30th.

Poster Presentation- a visual display of research or ideas, where presenters discuss their work and accomplishments one-on-one with attendees.
- Suggested theme for posters: CHW Stories of Success, but other topics are also welcome.
Please select the type of training you are wanting to present at the conference.*

SE CHW Network members have shown interest in the following topics. Please select all that may apply to your potential presentation.

CHW programming in low- and middle-income communitiesCHWs and sustainability and financingNavigating/disseminating resources in local communitiesBeing more effective in helping clients build strong communitiesInformation Technology and CHWs, including helping clients navigate tech and how AI will affect the workforceCHWs and relationship/trust building with clientsCHW ToolkitsMaternal healthDrivers of healthCultural humilityRacial and social justiceOther
If you chose "Other" please specify the topic.
Presentation Title
(20 word maximum)
Presentation Abstract/Description
(200 word maximum)
Please Note: If you are selected to present at the conference, your presentation must align with the Community Health Worker (CHW) Core Competencies and Skills. In addition, you will be required to develop clearly defined Learning Objectives and SMARTIE Goals for your session.

Learning Objectives are specific, measurable statements that describe what participants are expected to learn or achieve by the end of a training or presentation. These objectives help guide content development and ensure that the session is purposeful and outcomes-based. We ask for them to begin each learning objective with a verb.

SMARTIE Goals are an enhanced version of SMART goals. They are:
- Specific: Clearly defined and focused.
- Measurable: Quantifiable or able to be evaluated.
- Achievable: Realistic given the resources and constraints.
- Relevant: Aligned with broader goals and the needs of the audience.
- Time-bound: Set within a specific timeframe.
- Inclusive: Reflective of diversity and accessible to all.
- Equitable: Promotes fairness and addresses systemic barriers.
These components ensure that your session is intentional, impactful, and aligned with the values of equity and inclusivity.

Priority will be given to presentations that relate to the summit theme and topics of interest of network members
Presentation Presenter(s)
How many presenters will you have?

Presenter One's Information
Full Name

First NameLast Name
Title
Name of Organization
Organization Contact Information & Website (if applicable)
Applicant Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Bio (250-word max.)
Please indicate if applicant is a CHW

YesNo

Presenter Two's Information
Full Name

First NameLast Name
Title
Name of Organization
Organization Contact Information & Website (if applicable)
Applicant Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Bio (250-word max.)
Please indicate if applicant is a CHW

YesNo

Presenter Three's Information
Full Name

First NameLast Name
Title
Name of Organization
Organization Contact Information & Website (if applicable)
Applicant Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Bio (250-word max.)
Please indicate if applicant is a CHW

YesNo

Presenter Four's Information
Full Name

First NameLast Name
Title
Name of Organization
Organization Contact Information & Website (if applicable)
Applicant Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Bio (250-word max.)
Please indicate if applicant is a CHW

YesNo

Panelist One's Information
Full Name

First NameLast Name
Title
Name of Organization
Organization Contact Information & Website (if applicable)
Applicant Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Bio (250-word max.)
Please indicate if applicant is a CHW

YesNo

Panelist Two's Information
Full Name

First NameLast Name
Title
Name of Organization
Organization Contact Information & Website (if applicable)
Applicant Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Bio (250-word max.)
Please indicate if applicant is a CHW

YesNo

Panelist Three's Information
Full Name

First NameLast Name
Title
Name of Organization
Organization Contact Information & Website (if applicable)
Applicant Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Bio (250-word max.)
Please indicate if applicant is a CHW

YesNo

Panelist Four's Information
Full Name

First NameLast Name
Title
Name of Organization
Organization Contact Information & Website (if applicable)
Applicant Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Bio (250-word max.)
Please indicate if applicant is a CHW

YesNo

Presenter One's Information
Full Name

First NameLast Name
Title
Name of Organization
Organization Contact Information & Website (if applicable)
Applicant Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Bio (250-word max.)
Please indicate if applicant is a CHW

YesNo

Presenter Two's Information
Full Name

First NameLast Name
Title
Name of Organization
Organization Contact Information & Website (if applicable)
Applicant Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Bio (250-word max.)
Please indicate if applicant is a CHW

YesNo

Presenter Three's Information
Full Name

First NameLast Name
Title
Name of Organization
Organization Contact Information & Website (if applicable)
Applicant Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Bio (250-word max.)
Please indicate if applicant is a CHW

YesNo

Presenter Four's Information
Full Name

First NameLast Name
Title
Name of Organization
Organization Contact Information & Website (if applicable)
Applicant Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Bio (250-word max.)
Please indicate if applicant is a CHW

YesNo

Presenter One's Information
Full Name

First NameLast Name
Title
Name of Organization
Organization Contact Information & Website (if applicable)
Applicant Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Bio (250-word max.)
Please indicate if applicant is a CHW

YesNo

Presenter Two's Information
Full Name

First NameLast Name
Title
Name of Organization
Organization Contact Information & Website (if applicable)
Applicant Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Bio (250-word max.)
Please indicate if applicant is a CHW

YesNo

Presenter Three's Information
Full Name

First NameLast Name
Title
Name of Organization
Organization Contact Information & Website (if applicable)
Applicant Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Bio (250-word max.)
Please indicate if applicant is a CHW

YesNo

Presenter Four's Information
Full Name

First NameLast Name
Title
Name of Organization
Organization Contact Information & Website (if applicable)
Applicant Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Bio (250-word max.)
Please indicate if applicant is a CHW

YesNo

Presenter Five's Information
Full Name

First NameLast Name
Title
Name of Organization
Organization Contact Information & Website (if applicable)
Applicant Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Bio (250-word max.)
Please indicate if applicant is a CHW

YesNo

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Presentation Presenter(s)

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Roundtable Presenter(s) Information

Workshops Information

Workshop Presenter(s) Information

Poster Presentation Information

Poster Presentation Author(s) Information

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