APC Professional Education Webinar Proposal Webinar Title(Required)Title is subject to final editing Presenter(Required)Presenter will be the main contact unless specified otherwise Presentation DetailsTopic(Required)AdvocacyAlternative TherapiesAssessmentCrisisDisasterDiversityDocumentationEthicsOne-person DepartmentsPartnershipsPatient SatisfactionResearchSelf CareStaff CareTechnologyVolunteersWho Should Attend? (target audience)(Required) Our membership is religiously and culturally diverse. Will this presentation reflect aspects of more than one culture and/or religion?(Required) Yes No If no, will your presentation be respectful of other religious and cultural traditions? Or is it intended to educate participants on a particular religion/culture? Please explain:The APC categorizes webinars on three levels: Beginner, Intermediate, and Advanced. Use the definitions below to categorize your webinar appropriately.Beginner – Basic information on the topic for those with little background in the area. Intermediate – Basic plus additional information on the topic for those with some background in the area Advanced – Specialized information on the topic for those with extensive experience and/or knowledge in the area.Level(Required) Beginner Intermediate Advanced Educational Objectives and DescriptionAs a result of this educational opportunity, participants will be able to: Educational Objectives and description will appear in promotional materials and are subject to final editing.Educational Objectives (Limit 3)(Required)Please use the purple oval to the right to add objectives. Add RemoveDescription(Required)Educational opportunity description should not repeat the objectives listed in the previous field.Webinar RequirementsPlease note: Because the webinar slides, audio and materials will be presented to a live audience as well as recorded, you must present original material or obtain the author/copyright holder’s permission.By initialing below, I agree to obtain any necessary copyright permissions for my presentation.(Required) PresenterName (as it should appear in print)(Required) Highest Degree and Credentials(Required) Certified by Place of Work(Required) Title(Required) Mailing Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)E-mail Address(Required) Religious Affiliation (if any) Member of(Required)(check all that apply) APC ACPE CASC/ACSS NACC NAJC Other: Resume/Curriculum Vitae Upload(Required)Please include a list of any professional presentations and/or published works. Drop files here or Select files Accepted file types: doc, docx, pdf, Max. file size: 20 MB, Max. files: 2. Member of (other):(Required) Your experience with the webinar topic(Required)I would like to add additional presenters Yes No Co-Presenter – 1Name (as it should appear in print) Highest Degree and Credentials Certified by Place of Work Title City State PhoneE-mail Religious Affiliation (if any) Member of(check all that apply) APC ACPE CASC/ACSS NACC NAJC Other: Resume/Curriculum Vitae UploadPlease include a list of any professional presentations and/or published works. Drop files here or Select files Accepted file types: doc, docx, pdf, Max. file size: 20 MB, Max. files: 2. Member of (other): Your experience with the webinar topicI would like to add additional presenters Yes No Co-Presenter – 2Name (as it should appear in print) Highest Degree and Credentials Certified by Place of Work Title City State PhoneE-mail Religious Affiliation (if any) Member of(check all that apply) APC ACPE CASC/ACSS NACC NAJC Other: Resume/Curriculum Vitae UploadPlease include a list of any professional presentations and/or published works. Drop files here or Select files Accepted file types: doc, docx, pdf, Max. file size: 20 MB, Max. files: 2. Member of (other): Your experience with the webinar topicI would like to add additional presenters Yes No Co-Presenter – 3Name (as it should appear in print) Highest Degree and Credentials Certified by Place of Work Title City State PhoneE-mail Religious Affiliation (if any) Member of(check all that apply) APC ACPE CASC/ACSS NACC NAJC Other: Resume/Curriculum Vitae UploadPlease include a list of any professional presentations and/or published works. Drop files here or Select files Accepted file types: doc, docx, pdf, Max. file size: 20 MB, Max. files: 2. Member of (other): Your experience with the webinar topicNameThis field is for validation purposes and should be left unchanged. Δ APC Professional Education Webinar Proposal Webinar Title(Required)Title is subject to final editing Presenter(Required)Presenter will be the main contact unless specified otherwise Presentation DetailsTopic(Required)AdvocacyAlternative TherapiesAssessmentCrisisDisasterDiversityDocumentationEthicsOne-person DepartmentsPartnershipsPatient SatisfactionResearchSelf CareStaff CareTechnologyVolunteersWho Should Attend? (target audience)(Required) Our membership is religiously and culturally diverse. Will this presentation reflect aspects of more than one culture and/or religion?(Required) Yes No If no, will your presentation be respectful of other religious and cultural traditions? Or is it intended to educate participants on a particular religion/culture? Please explain:The APC categorizes webinars on three levels: Beginner, Intermediate, and Advanced. Use the definitions below to categorize your webinar appropriately.Beginner – Basic information on the topic for those with little background in the area. Intermediate – Basic plus additional information on the topic for those with some background in the area Advanced – Specialized information on the topic for those with extensive experience and/or knowledge in the area.Level(Required) Beginner Intermediate Advanced Educational Objectives and DescriptionAs a result of this educational opportunity, participants will be able to: Educational Objectives and description will appear in promotional materials and are subject to final editing.Educational Objectives (Limit 3)(Required)Please use the purple oval to the right to add objectives. Add RemoveDescription(Required)Educational opportunity description should not repeat the objectives listed in the previous field.Webinar RequirementsPlease note: Because the webinar slides, audio and materials will be presented to a live audience as well as recorded, you must present original material or obtain the author/copyright holder’s permission.By initialing below, I agree to obtain any necessary copyright permissions for my presentation.(Required) PresenterName (as it should appear in print)(Required) Highest Degree and Credentials(Required) Certified by Place of Work(Required) Title(Required) Mailing Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)E-mail Address(Required) Religious Affiliation (if any) Member of(Required)(check all that apply) APC ACPE CASC/ACSS NACC NAJC Other: Resume/Curriculum Vitae Upload(Required)Please include a list of any professional presentations and/or published works. Drop files here or Select files Accepted file types: doc, docx, pdf, Max. file size: 20 MB, Max. files: 2. Member of (other):(Required) Your experience with the webinar topic(Required)I would like to add additional presenters Yes No Co-Presenter – 1Name (as it should appear in print) Highest Degree and Credentials Certified by Place of Work Title City State PhoneE-mail Religious Affiliation (if any) Member of(check all that apply) APC ACPE CASC/ACSS NACC NAJC Other: Resume/Curriculum Vitae UploadPlease include a list of any professional presentations and/or published works. Drop files here or Select files Accepted file types: doc, docx, pdf, Max. file size: 20 MB, Max. files: 2. Member of (other): Your experience with the webinar topicI would like to add additional presenters Yes No Co-Presenter – 2Name (as it should appear in print) Highest Degree and Credentials Certified by Place of Work Title City State PhoneE-mail Religious Affiliation (if any) Member of(check all that apply) APC ACPE CASC/ACSS NACC NAJC Other: Resume/Curriculum Vitae UploadPlease include a list of any professional presentations and/or published works. Drop files here or Select files Accepted file types: doc, docx, pdf, Max. file size: 20 MB, Max. files: 2. Member of (other): Your experience with the webinar topicI would like to add additional presenters Yes No Co-Presenter – 3Name (as it should appear in print) Highest Degree and Credentials Certified by Place of Work Title City State PhoneE-mail Religious Affiliation (if any) Member of(check all that apply) APC ACPE CASC/ACSS NACC NAJC Other: Resume/Curriculum Vitae UploadPlease include a list of any professional presentations and/or published works. Drop files here or Select files Accepted file types: doc, docx, pdf, Max. file size: 20 MB, Max. files: 2. Member of (other): Your experience with the webinar topicNameThis field is for validation purposes and should be left unchanged. Δ
Association of Professional ChaplainsAssociation of Professional Chaplains
