2023 CEU Request Form Survey

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* Session Length:

1 hour 15 minutes (0.1 CEUs)

2 hours 30 minutes (0.2 CEUs)

Other (please specify)

Learning Outcomes
These are measurable behavior or performance objectives. A minimum of 3 outcomes are required.

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* Learning Outcome #1:

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* Learning Outcome #2:

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* Learning Outcome #3:

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* Additional Learning Outcomes:

Presentation Outline
Please associate items in the outline to the Learning Objectives above. Use the format topic, timeline and presentation method. Example - Introduction (5 minutes), lecture & PowerPoint (30 minutes), breakout groups (15 minutes), Q&A (10 minutes), etc.

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* Outline #1:

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* Outline #2:

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* Outline #3:

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* Outline #4:

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* Outline #5:

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* Outline #6:

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* Outline #7:

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* Core Content Areas:

Collaboration / Partnerships

Finance / Budgeting

Future Trends

Leadership

Professionalism / Ethics

Programming

Research

Technology

Other (please specify)

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* Speaker Name:

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* Title & Organization:

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* Email Address:

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* Has this speaker presented on this topic before? If yes, when and where? Please provide a few recent examples.

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* Please provide a brief speaker bio.

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* Speaker #2 Name (if applicable)

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* Title & Organization:

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* Email Address:

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* Has this speaker presented on this topic before? If yes, when and where? Please provide a few recent examples.

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* Please provide a brief speaker bio.

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* Speaker #3 Name (if applicable)

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* Title & Organization:

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* Email Address:

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* Has this speaker presented on this topic before? If yes, when and where? Please provide a few recent examples.

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* Please provide a brief speaker bio.

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* Please provide a speaker photo, if possible.

PNG, JPG, JPEG, GIF file types only.

Choose File

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* Supplemental Materials (optional) - Please upload any relevant session materials here.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Proposal submitted by (if different from the speaker):

2023 CEU Request Form

Please fill out this form if you are submitting a session proposal for CEU approval.

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* Session Title:

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* Session Date:

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* Session Location:

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* Session Description:

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* Session Length:

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* Learning Outcome #1:

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* Learning Outcome #2:

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* Learning Outcome #3:

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* Additional Learning Outcomes:

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* Outline #1:

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* Outline #2:

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* Outline #3:

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* Outline #4:

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* Outline #5:

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* Outline #6:

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* Outline #7:

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* Core Content Areas:

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* Speaker Name:

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* Title & Organization:

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* Email Address:

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* Has this speaker presented on this topic before? If yes, when and where? Please provide a few recent examples.

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* Please provide a brief speaker bio.

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* Speaker #2 Name (if applicable)

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* Title & Organization:

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* Email Address:

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* Has this speaker presented on this topic before? If yes, when and where? Please provide a few recent examples.

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* Please provide a brief speaker bio.

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* Speaker #3 Name (if applicable)

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* Title & Organization:

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* Email Address:

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* Has this speaker presented on this topic before? If yes, when and where? Please provide a few recent examples.

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* Please provide a brief speaker bio.

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* Please provide a speaker photo, if possible.

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* Supplemental Materials (optional) - Please upload any relevant session materials here.

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* Please enter name, title, organization and email address below.