Please use this survey to submit your abstract to present at the 2021 Transforming Care Conference.

Completed proposals must be submitted by Monday, May 31st, 2021, at 11:59 PM EST.

Question Title

* 1. Please provide your full name.

Question Title

* 2. Please tell us your pronouns (select all that apply)

Question Title

* 3. Credentials (if applicable)

Question Title

* 4. Any organizational affiliations

Question Title

* 5. Email

Question Title

* 6. Phone

Question Title

* 7. Please tell us what kind of presentation you're submitting.

Please note that both virtual and in-person presentations are available, and that you may select more than one option.

Question Title

* 8. Presentation/Workshop/Panel/Poster Title

Question Title

* 9. Presentation/Workshop/Panel/Poster Description (max 500 words)

Question Title

* 10. Please provide a brief (100 words max) description of your submission to publish in the conference agenda

Please provide 3 Learning Objectives for your Presentation*

(Learning objectives must be written using action verbs that demonstrate behaviors (analyze, identify, compare, develop, interpret, assess, etc). “Understand” and “know” are examples of words that should NOT be used in your learning objectives. )

Question Title

* 11. Learning Objective #1

By the end of this presentation, participants will be able to:

Question Title

* 12. Learning Objective #2

By the end of this presentation, participants will be able to:

Question Title

* 13. Learning Objective #3

By the end of this presentation, participants will be able to:

Question Title

* 14. Who are your intended audiences? Check all that apply

Question Title

* 15. What kind of expertise would audience members ideally already have when attending this session?

Question Title

* 16. Please provide a brief bio (max of 150 words) for each presenter, panelist, or moderator, including their pronouns.

These will be published on our Conference Agenda.

Question Title

* 17. If you have any co-presenters , moderators, or panelists, please provide their names, phone numbers, and email addresses.

Note that anyone who facilitates the learning process in your presentation, regardless of the size of their impact, is considered a co-presenter.

If you are presenting solo, type N/A.

Question Title

* 18. Please attach the Resume/CV for each presenter, moderator, or panelist.

If you are presenting solo, you need only upload this for yourself-- then you may skip to question 25.

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

Question Title

* 19. (If applicable) Please attach the resume/CV for your second presenter, moderator, or panelist

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

Question Title

* 20. (If applicable) Please attach the resume/CV for your third presenter, moderator, or panelist

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

Question Title

* 21. (If applicable) Please attach the resume/CV for your fourth presenter, moderator, or panelist

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

Question Title

* 22. If you have any additional documents (example slides, auxiliary materials, etc), please attach them here.

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

Question Title

* 23. Do you have any needs for your presentation as far as room setup needs, technology needs, etc.?

T