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Submitter Contact Information:

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Webinar Title:

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Select Preferred Webinar Length:

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What practice-based problem (gap) will this education address?
Examples: Improve care coordination; Better communication with patients and families; Want to give better feedback to students

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What change(s) in strategy, performance, or patient care would you like this education to help learners accomplish?
Examples: Eliminate stigmatizing language from communications with patients; Improve my management skills

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References
List relevant data sources supporting the noted issue in practice the activity is addressing. Please place each reference on a separate line.
Sample Format:
Author(s). Published work (Edition). (Year). Publisher location: Publisher

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Target Audience (Select all that apply):

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Practice Setting (Select all that apply):

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Learning Objectives
Learning objectives should describe the intended educational outcome of this activity to address a change in knowledge, competence, or performance.
By the end of the session, participants will be able to:

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Audience Engagement
Please select the audience engagement option(s) you will use during the presentation. Select all that apply.

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Please list the speakers that will participate in this activity.
Format:
Speaker 1 Formal Name, Credentials
Email Address
Title, Organization
List the speaker’s employer(s) using company name.

Speaker 2 Formal Name, Credentials
Email Address
Title, Organization
List the speaker’s employer(s) using company name.

Thank you for submitting a proposal. The planning committee reviews webinar proposals on an ongoing basis. Proposal submitters will receive an email notification after the review process is complete. If you have any questions, please email Linda Lang at llang@paltc.org.

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