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2019 SS Proposal Form - New Presenters
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Introduction
Thank you for your interest in presenting at the Summer School. We hope you will consider joining us in 2019! Please complete the online form below. These forms are brief, but please be sure that your course descriptions are specific for our review team, and for possible publication in the program.
Proposal Deadline: December 28, 2018
Proposals are reviewed by a regional review team, and presenters will be notified about course acceptance status in early 2019.
Once you have completed the form, click on the orange "submit" button at the end of the form.
Thank you!
First Name
*
Last Name
*
Email Address
*
Phone
*
Alternate Email Address
Address
*
Employer
*
Biographical Information
Please include a short biographic paragraph below:
Biography
*
Highest Degree Earned
*
Date Earned
*
Proposed Course
Course Type
*
Prevention
Intervention
Treatment
Recovery
Related Issues
Length
*
1 Day
2 Days
3 Days
4 Days
Course Title
*
Course Description
*
Please provide a brief overview paragraph that accurately describes the proposed course and is suitable for publication. In the description, please note any evidence-based practice or best practice featured in this course.
Learning Objectives
*
Please list at least 3.
Content Level:
*
Please check off applicable content level(s).
Core
Intermediate
Advanced
IC & RC Domains, if applicable:
Tentative Schedule - Available date(s) to teach:
*
Please indicate all dates that you can be available to teach.
Monday, June 3 (Half Day in Afternoon)
Tuesday, June 4 (Full Day)
Wednesday, June 5 (Full Day)
Thursday, June 6 (Full Day)
Previous New England Institute Experience
If you have presented this course at a Summer School Program before,
please note the event and date.
Previous Presentation Date
*
Previous Presenter Experience
Please list the 5 previously taught workshops with name,
length, and location below:
Previous Workshops
*
References
Please provide the names, emails, and phone numbers for 2 references who can speak to your ability as a presenter.
If selected:
*
If course is accepted, I agree to provide the Institute with all requested information by deadlines.
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