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Application to Present a Webinar

Instructions

1. First Name

2. Last Name

3. Email Address

4. Presenter Phone Number

5. US Mail Address

6. Degree(s) and Year Earned

7. Your Organization/Business Affiliation

8. Biography
Please submit a brief biography (limit to 100 words) written in the third person. This will be used in our marketing.

9. Prior Presentation Experience
Please describe, and if available provide links to any sample of work.

10. Title of Presentation

11. Brief Presentation Description
This information should describe your presentation to those who would be interested in attending.

12. Please provide a minimum of 3 educational learning objectives for your presentation. Each objective should complete the sentence: "Upon completion of this session, participants will be able to ..."

13. What is the Format of Your Presentation?
Check all that apply

Experiential/Collaborative
Interactive Discussion
Personal Experience/Reflection
Skill Practice/Role Play
Panel
Lecture

14. This presentation is intended for what level of a participants' knowledge?

15. Please provide a minimum of 3 content references (APA format) for your presentation. At least three references are required to be less than 10 years old and peer reviewed (i.e. Journal Articles).

16. Presentation Duration
What presentation duration is best for your training program?

60 minutes
90 minutes (typical)
3 hours
6 hours

17. Expected Participants
Please describe the targeted audience for your presentation AND the number of attendees that will be best fit for your type of presentation.

18. Presenter Expertise
Please describe your expertise specific to the topic of your presentation.

19. Presentation's Current Level of Development
Please check all boxes that apply.

Presentation is scripted and ready to go
Supporting materials/attachments are completed
Content references are listed
A free handout (short video or article) is available
Chat questions, quizzes, polls, and other engagement activities are developed
A sales/marketing page for the presentation is completed
Stable internet connection in place
Quality mic and video camera is available
If presentation is not currently completed, it can be within 3 months

20. Please upload a current CV/Resume.

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