2024 APC/NACC Joint Conference PDI Proposal PROFESSIONAL DEVELOPMENT INTENSIVE (PDI) PROPOSALAPPLICATION DEADLINE: Submitted No Later Than Friday, August 25, 2023 PDI Title (title is subject to final editing)(Required) Lead Presenter (lead presenter will be the main contact unless specified otherwise)(Required) Presentation DetailsTopic (please select one from the list below):(Required)Advance Care PlanningAdvocacyAlternative TherapiesAssessmentCrisisDisasterDiversity/Equity/InclusionDocumentationEthicsManagement/AdministrationOne-Person DepartmentsPartnershipsPatient SatisfactionResearchSelf-CareStaff-CareTechnologyVolunteers/VolunteeringSession Length (please select from the list below):(Required)4-Hour8-HourEitherLevel (please select one):(Required) 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. The APC/NACC categorizes workshops on three levels: Beginner, Intermediate, and Advanced. Use the definitions above to categorize your session appropriately.Format (please select one):(Required) Lecture Interactive Panel Experiential Other Our membership is religiously and culturally diverse. Will this presentation reflect aspects of more than one culture and/or religion? 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:ExplanationEducational Objectives and DescriptionEducational Objectives and description will appear in promotional materials and are subject to final editing.Educational Objectives: Limit 3 goals.(Required) Add RemoveAs a result of this educational opportunity, participants will be able to:Description – Limit 100 words.Educational opportunity description should not repeat above objectivesProfessional Development Intensive RequirementsThe information below MUST be completed. Incomplete fields will disqualify the PDI proposal form. In order to be considered for presenting at the 2024 APC/NACC Annual Conference each statement MUST be initialed. Please 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.Please Initial below(Required) I agree to obtain any necessary copyright permissions for my presentation.Please Initial below(Required) PRESENTATION PLAN – I will provide the presentation plan in electronic format to APC/NACC, SUBMITTED no later than Friday, April 12, 2024Please Initial below(Required) PRESENTATION MATEIRALS – I will provide any presentation materials in electronic format to APC/NACC for distribution to the attendees of the Professional Development Intensives no later than Friday, May 24, 2024. It will be the presenter’s responsibility to provide presentation materials at the PDI session if they were not provided to APC/NACC in advance.Main Presenter(Attach a short bio and a resume/curriculum vitae including professional presentations and published works.)Name (as it should appear in print):(Required) Highest Degree and Credentials:(Required) Certified by:(Required) Place of Work:(Required) Title:(Required) Mailing Address:(Required) City:(Required) State:(Required) Zip Code:(Required) Phone(Required)Email(Required) Upload your C/V(Required)Max. file size: 10 MB.Religious Affiliation (if any): Member of:(Required) APC ACPE CASC/ACSS NACC NAJC Other: (check all that apply)Member of (Other): Your experience with the session topic (Limit 50 words):Do you have additonal presenters?(Required) Yes No Additional PresentersCo-Presenter – 1Name (as it should appear in print):(Required) Highest Degree and Credentials:(Required) Certified by:(Required) Place of Work:(Required) Title:(Required) City:(Required) State:(Required) Phone:(Required)E-mail:(Required) Religious Affiliation (if any): Upload your C/V(Required)Max. file size: 10 MB.Member of:(Required) APC ACPE CASC/ACSS NACC NAJC Other: (check all that apply)Member of (Other): Your experience with the session topic (Limit 50 words):Do you have additonal presenters?(Required) Yes No Co-Presenter – 2Name (as it should appear in print):(Required) Highest Degree and Credentials:(Required) Certified by:(Required) Place of Work:(Required) Title:(Required) City:(Required) State:(Required) Phone:(Required)E-mail:(Required) Religious Affiliation (if any): Upload your C/V(Required)Max. file size: 10 MB.Member of:(Required) APC ACPE CASC/ACSS NACC NAJC Other: (check all that apply)Member of (Other): Your experience with the session topic (Limit 50 words):Do you have additonal presenters?(Required) Yes No Co-Presenter – 3Name (as it should appear in print):(Required) Highest Degree and Credentials:(Required) Certified by:(Required) Place of Work:(Required) Title:(Required) City:(Required) State:(Required) Phone:(Required)E-mail:(Required) Religious Affiliation (if any): Upload your C/V(Required)Max. file size: 10 MB.Member of:(Required) APC ACPE CASC/ACSS NACC NAJC Other: (check all that apply)Member of (Other): Your experience with the session topic (Limit 50 words):Do you have additonal presenters?(Required) Yes No Co-Presenter – 4Name (as it should appear in print):(Required) Highest Degree and Credentials:(Required) Certified by:(Required) Place of Work:(Required) Title:(Required) City:(Required) State:(Required) Phone:(Required)E-mail:(Required) Religious Affiliation (if any): Upload your C/V(Required)Max. file size: 10 MB.Member of:(Required) APC ACPE CASC/ACSS NACC NAJC Other: (check all that apply)Member of (Other): Your experience with the session topic (Limit 50 words):(Required)Do you have additonal presenters?(Required) Yes No Co-Presenter – 5Name (as it should appear in print):(Required) Highest Degree and Credentials:(Required) Certified by:(Required) Place of Work:(Required) Title:(Required) City:(Required) State:(Required) Phone:(Required)E-mail:(Required) Religious Affiliation (if any): Upload your C/V(Required)Max. file size: 10 MB.Member of:(Required) APC ACPE CASC/ACSS NACC NAJC Other: (check all that apply)Member of (Other): Your experience with the session topic (Limit 50 words):(Required)If you have a sixth (or more) Co-Presenter(s), please upload their information below.Upload your C/VMax. file size: 10 MB.CommentsThis field is for validation purposes and should be left unchanged. Δ
Association of Professional ChaplainsAssociation of Professional Chaplains
