2020 EBP Symposium - Poster 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 Poster Presentation

Submission Deadline (EXTENSION): March 12, 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.

This submission form is only for Poster Presentations.

1. Presenter A - Name and Contact Information *This question is required.

	First Name
	Last Name
	Official Title
	Agency/Organization Affiliation
	Address
	Email Address
	Work Phone Number
	Cell Phone Number
	ADA/Special/Dietary Needs

2. Presenter A - What is your role? Please select the one that best describes your role. *This question is required.

3. Presenter B - Name and Contact Information

Leave blank if not applicable.

	First Name
	Last Name
	Official Title
	Agency/Organization Affiliation
	Address
	Email Address
	Work Phone Number
	Cell Phone Number
	ADA/Special/Dietary Needs

4. Presenter B - What is your role? Please select the one that best describes your role.

Leave blank if not applicable.

5. Presenter C - Name and Contact Information

Leave blank if not applicable.

	First Name
	Last Name
	Official Title
	Agency/Organization Affiliation
	Address
	Email Address
	Work Phone Number
	Cell Phone Number
	ADA/Special/Dietary Needs

6. Presenter C - What is your role? Please select the one that best describes your role.

Leave blank if not applicable.

7. Title of Your Presentation (maximum 15 words)

Use mixed-case letters (upper-case for the first letter of all words with 4 or more letters and lower-case letters for the remainder of the words) and appropriate punctuation.
*This question is required.

8. Abstract (maximum 50 words)

Enter a brief description of your professional presentation or panel discussion. This description will appear in the symposium program. *This question is required.

9. Presentation Summary

Please enter a detailed summary of your presentation. We recommend a 750-word summary; please use as many words desired for your presentation summary. The presentation summary may include: a detailed description of an evidence-based, promising, emerging, or community-defined practice; target population; characteristics of individuals served; outcomes for homelessness, housing, and/or behavioral health; and findings or impact of practice on outcomes. *This question is required.

10. 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.

	Presenter A
	Presenter B
	Presenter C

11. 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.

Please enter an 'other' value for this selection.

12. 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.

2020 EBP Symposium - Poster Proposal Form

Proposal Form for Professional Presentation or Panel Discussion