All questions are required unless otherwise noted.  The deadline for submitting proposals is September 15, 2019.

Contact the conference coordinator at confcoor@gmail.com for any questions you may have about the 2020 Alaska Health Summit RFP process.

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* 1. Presentation Title

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* 2. Primary Presenter Name

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* 3. Primary Presenter current job title to be listed in program:

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* 4. Primary Presenter current employer (full organization name):

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* 5. Primary Presenter phone number:

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* 6. Primary Presenter cell phone number:

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* 7. Please list any degrees, licences or certifications you may have (CHAP, DHAT, RN, RD, MA, PhD, DDS, MPH, MD, etc.)

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* 8. Please list additional people who will be co-presenting.  A name and email address is required of each co-presenter to be considered. This number cannot exceed 3 more for a total of 4 maximum. We will send an email to each additional presenter asking for the necessary information (insert NA in the required fields if there are no other presenters).

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* 9. Please select the session type(s) for which you would like your proposal to be considered.

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* 10. In what timeframe can your topic be covered? Choose all that apply.

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* 11. Session Description (must not exceed 150 words):

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* 12. Please identify 3 learning objectives that reflect what attendees will achieve by attending this session. Objectives should be in behavioral terms such as “discuss, describe, list, identify, analysis, synthesize”, and not as “understand or know”.

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* 13. Select up to 6 learning areas that apply. Like learning objectives, this is important for CE.

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* 14. Does your abstract/project relate to any of the 16 HA 2020 Objectives listed below? (check all that apply)

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* 15. Please describe your expertise and years of education/experience specific to the educational activity (this is a short paragraph to include a minimum of 3-5 sentences).

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* 16. The theme of the 2020 Health Summit is "Creating Healthy Alaskans: For Science, For Action, For Equity". Identify the theme(s)/track(s) with which this session most closely aligns. Please note this question does not influence the selection of proposals.

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* 17. Please tell us which region in Alaska your proposal applies to:

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