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REPRESENT! NCCPA Summit Speaker Forms

The REPRESENT! NCCPA Summit is a biennial gathering of physician assistants (PAs), PA faculty, PA students, organizational leaders, physicians, and employers committed to increasing the representation of historically underserved groups within the PA profession. The inaugural Summit was held in 2022, followed by the 2024 event, and the next Summit will take place September 18–19, 2026, in Atlanta, GA.

The Summit is designed for clinically practicing PAs, PA educators, leaders of PA organizations, physicians, and employers. We welcome PAs who are interested in advancing the objectives of building a more inclusive workforce and strengthening representation within the PA profession. NCCPA is seeking presentations that reflect research or evidence-based practice related to the following themes:

· Inclusiveness: highlight strategies that support the development of an inclusive healthcare workforce.
· Expanding Representation: Strategies to improve access and/or opportunity in the PA profession.
· Barriers to Care: System-level factors influencing health outcomes.
· Community or Social Drivers of Health: How external factors shape patient well-being.
· Workforce Pathways: Approaches to strengthen entry and/or advancement in the PA profession.
· Reducing Bias: Practical methods for clinical practice or education.
· Well-being and Resilience: Initiatives supporting PAs or PA students.
· Leadership and Collaboration: Models that foster connection and representation.
· Identity and Health: Impact of intersecting factors on access or outcomes.
· Policy and Organizational Change: practices that improve fairness and inclusivity in health care delivery.
· Health Systems Research: Examining structures, resource allocation, or models that shape workforce or patient outcomes.
1.General info to send honorarium:
2.Your job title (for program):
3.Please include a brief biography:
4.Title of your presentation/small group discussion:
5.Detailed description of your presentation/small group discussion:
6.List 3 objectives for your presentation/small group discussion:
7.Please describe your experience presenting and speaking on this topic:
8.Do you intend to discuss any unapproved/investigational use of a commercial product/device during this educational activity?
9.I attest that my presentation will provide a balanced view of therapeutic options and will be entirely free of promotional bias.
10.Disclosure
All persons who may impact the content of a CME activity, including faculty and planners, are required to fully disclose current and recent financial relationships with commercial interests. A conflict of interest may be considered to exist if such a person has financial relationships with the grantor or any non-eligible entities (commercial interests) that may have a direct impact on the content of the program. Financial relationship is defined as being a shareholder, consultant, grant recipient, research participant, employee, and/or recipient of other financial or material support. Recent is defined as within the past 24 months. The participants in this CME activity must be made aware of any such financial relationship(s).This disclosure policy is intended to protect all parties involved from any potential conflict of interest that may arise.
Non-declaration Statement
I declare that I do NOT have a current financial relationship with the grantor and/or any non-eligible entities (commercial interests) that may have a direct interest in the subject matter of the CME program. (If you answer NO, then complete the disclosure form and attach in question 11 below to disclose financial relationship).
11.If my submission is accepted, I understand that NCCPA will cover airfare to/from ATL from my U.S. home address.
12.If my submission is accepted, I understand that NCCPA will cover 2 nights at the conference hotel on Sept 17th and 18th, 2026.
13.I agree to submit the required copyright statement and permissions by July 15th, 2026. I understand that all faculty are responsible for securing copyright releases for all text, graphics, and photos taken from other sources and providing copies of these releases to NCCPA.(Required.)
14.I agree to include a statement on the disclosure slide in my presentation if AI was used in one or more sections of this presentation or its related handout(s). I agree to credit/reference AI on the individual slide(s) where AI was used when I submit my slides by July 15th, 2026.(Required.)
15.I agree to submit a final slide deck presentation by July 15th, 2026. Slide deck must contain a faculty disclosure slide.(Required.)