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To assist the ALCA on meeting our strategic goals and collect data on the number and types of presentations given by our members, please complete the following form each time you make a connection with an academic institution or give a presentation to any audience. Thank you. 

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* 1. ALCA Member Contact Info:

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* 2. Organization Contact Info:

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* 3. Type of contact made: 

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* 4. Presentation Information

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* 5. Size of audience

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* 6. Audience make-up. Select all that apply.

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* 7. Was your session approved for CEs?

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* 8. If yes, which CEs were pre-approved? Check all that apply.

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* 9. Did you use ALCA Materials in your presentation?

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* 10. Did you discuss ALCA membership / partnership in your presentation? Select all that apply.

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* 11. Did you include the ALCA 8 Knowledge Areas? Check all that apply. 

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* 12. Please share any additional comments here:

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* 13. Is there any follow up needed by ALCA Staff?

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