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2020 EBP Symposium - Presentation/Panel Proposal Form


California Institute for Behavioral Health Solutions and California Department of Health Care Services Presents
10th Annual Evidence-Based Practices Symposium:
Building a Life Beyond Homelessness

June 16-17, 2020 | Sacramento, CA

Proposal Form for Professional Presentation or Panel Discussion

Submission Deadline: March 9, 2020 at 11:59 p.m. PST

Call For Proposals: http://bit.ly/37mtWhr

Please contact Shirley Chan sychan@cibhs.org for questions about submitting a proposal.
1. Select Submission Type *This question is required.
2. Select the Amount of Time for Presentation *This question is required.
3. Presenter A - Name and Contact Information *This question is required.
4. Presenter A - What is your role? Please select the one that best describes your role. *This question is required.
5. Presenter B - Name and Contact Information

Leave blank if not applicable.
6. Presenter B - What is your role? Please select the one that best describes your role.

Leave blank if not applicable.
7. Presenter C - Name and Contact Information

Leave blank if not applicable.
8. Presenter C - What is your role? Please select the one that best describes your role.

Leave blank if not applicable.
12. Educational Objectives

Enter at least 3 educational objectives.

Objectives are not a list of the topics to be covered but must clearly define what the participant will know or be able to do as a result of having attended the program, and these objectives must be stated in measurable terms. They are used to measure the efficacy of the instructor making the clear connection between the content being delivered and application of the content within the learner’s professional context. Refer to Pages 9-11 as a guide to helping you choose the correct verbs for your learning objectives. All objectives must start with “As a result of attending this training, how satisfied are you that you are able to...” then utilize at least one of the approved verbs.

Here is an example of a well-written learning objective:
“As a result of attending this training, how satisfied are you that you are able to explain two ways that the Strengths Model can be used to design service delivery systems for justice-involved individuals.” *This question is required.
13. Subject Matter References

Enter at least three references for each submission.

Subject Matter References are needed to demonstrate the knowledge base(s) being utilized as the foundation of the training. Include relevant references for addressing the empirical support of the evidence-based content by either established research or peer-reviewed, published support for your topic.

Here is are examples of the format we are looking for:

Online reference:
Exercising while Learning Boost Test Scores, study finds, http://health.usnews.com/health-news/family-health/brain-andbehavior/ articles/2011/05/02/exercising-while-learning-boosts-testscores-study-finds. Established Research.

Published text reference:
Gendreau, P., Goggin, C., and Smith, P. (2000). The forgotten issue in effective correctional treatment: Program implementation. International Journal of Offender Therapy and Comparative Criminology, 43, 180-187.  Peer Reviewed. *This question is required.
14. Biography

Each presenter needs to submit a brief biography consisting of a paragraph of no more than 250 words. This biography will be incorporated into a listing of the Professional Bios with those from the other presenters and distributed to attendees at the conference as well as used to introduce you.

Enter "N/A" if your proposal does not include additional presenters. *This question is required.
15. Presenter A - Resume or CV File Upload

Each presenter’s resume or CV file must be in Adobe PDF format. Each presenter’s resume or CV will be used to verify their education level and/or the experience level of the presenter in the subject matter in which they will be presenting. *This question is required.
16. Presenter B - Resume or CV File Upload

Each presenter’s resume or CV file must be in Adobe PDF format.  
17. Presenter C - Resume or CV File Upload

Each presenter’s resume or CV file must be in Adobe PDF format. 
18. Audio Visual Needs

CIBHS will provide all the audio-visual equipment for the meeting. The meeting rooms will be set with the appropriate audio-visual equipment depending on the format of the presentation. The standard set up will include a screen, LCD projector, laptop, lectern/podium and microphone. If you will need sound for your presentations or you will be watching a DVD, you will need to request an audio patch. Panel presentations will include a head table. In larger rooms, there will be a riser and additional microphones as needed.

Please select all boxes that apply to your presentation.

Confirm that you do not need any audio-visual equipment and do not need internet.
If you require additional audio-visual equipment, please list your specific needs.

  *This question is required.
19. Special Accommodations

If you need accommodations such as a sign-language interpreter or other services, please let us know so that we can better respond to your needs. Please select one: *This question is required.
20. Taping and Publications

If you are selected, will you grant permission for taping (audio or video) of your session? *This question is required.
Please read and review your responses before clicking "Submit".  

After the submission deadline, March 9, no revisions can be made.