Request For Proposal

Please complete ALL information thoroughly and remember to include with your proposal a copy of your current CV. If you have handouts, these can also be included as an attachment. Presenter names, degrees, titles and organizations will be printed in event materials as they appear on this application. Electronic completion is preferred; email completed application to nwadebsrfp@gmail.com

ADEBS Proposal Form

Proposed Presentation Title*
Primary Presenter Name*
First Last
Proposed Presentation Topic*
- Options for Remains
- Memorialization
- Psychosocial Support
- Legacy
(please check one or more)
Title & Professional Degrees*
Organization*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
Brief Biographical Information
(provide information on your background, training and experience)
*Please attach current CV with your Proposal*
Please disclose any possible conflicts of interest
(A conflict of interest exists if any individual/entity that is in a position to influence the content, design or implementation of the activity is ALSO in a position to benefit financially from the success of the activity)
Brief Session Description (100 words or less).*
Please note, this event brings together both clinical and community audience—clarify whether your presentation is relevant for a clinical, lay or mixed audience.
References
Please list 1-2 references familiar with your presentation style and ability.
Reference 1 - Name/Title & Degrees*
Organization
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Reference 2 - Name/Title & Degrees*
Organization
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Co-Presenter
Co-Presenter Name (if applicable):
Title & Professional Degrees
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Phone
*Brief Biographical Information for brochure inclusion.
*Please attach current CV with your Proposal
Note that workshop slots will be 75 minutes long; please design your presentation accordingly.
If you are not selected to present a full workshop, would you be open to participation on an expert panel?
- Yes
- No
Target Audience (Select all that apply):
- Nurses
- Educators
- Bereavement Coordinators
- Hospice Aides
- Physicians
- Management & Leadership
- Social Workers
- Chaplains/Spiritual Care
- Support staff
- Counselors
- Volunteers/Coordinators
- Counselors
- Other
- Other
Please provide 2-3 Learning Objectives. Note: Learning objectives should identify what the participant will learn, not what the presenter will teach. Write objectives that are measurable and in complete sentences.
As an example:
(1) “By participating in this workshop, participants will . . .”
(2) “On completion of this session, participants will be able to . . .”
Learning Objective 1*
Learning Objective 2*
Learning Objective 3 (optional)
Please provide 1 “Trigger Question” designed to engage your audience in discussion. Plan to allow at least 5 minutes at the end of your presentation for discussion/Q&A with your audience.

Request For Proposal

ADEBS Proposal Form

References

Co-Presenter