2016 MASSW ANNUAL CONFERENCE WORKSHOP PROPOSAL

& CE APPLICATION FORM

November 3, 4, 5, 2016

Lansing Center ■ Lansing, Michigan

Instructions:

Please complete pages 2-5 and include resumes for all presenters. Incomplete proposals will not be considered. Preference will be given to presentations that feature best practices, and are most applicable to the interest of school social workers.

For questions regarding APA citations when completing the CE application form, please visit the following website:

Submit Electronically:

  • Complete this document electronically
  • Email completed document to: (please email this document with your last name as the title)
  • Attach a 1-2 page resume along with this document when submitting your proposal.

For any questions regarding this proposal or the application process, please contact:

Laura Milner, LMSW

Presenter Chair for 2015 MASSW Conference

Important Dates for Presenters:

  • April 1, 2016: Proposals due
  • May 1, 2016: Presenters selected and notified
  • October 1, 2016: Handouts for posting to web due
  • November 3, 4, 5, 2015: : MASSW Annual Conference

*Please submit by April 1, 2016*

Presentation Information:
Title of Presentation (10 words or less):
Application to School Social Work Practice (20 words or less):
Description of Workshop (for conference brochure / website):
Presentation Length: 1.5 hours (1 breakout session) 3.0 hours (2 breakout sessions)
Content Level:
Pre-K (students ages 3-4) Elementary School (students ages 5-11)
Middle School (students ages 12-14) High School (students ages 15-18)
Post High (students ages 19-26)
Instructional Method: Choose all that apply
Lecture Group Discussion Video Presentation (from internet)
Audio (music, etc.) Case Presentation Video Presentation (saved to laptop)
Movement Activities / Yoga, etc.
**Please note that all workshops will have a theatre-style room layout.**
Conference Availability: I am / we are available to present on the following days:
Thursday November 3, 2016 AM Friday, November 4, 2016 AM
Thursday November 3, 2016 PM Friday, November 4, 2016 PM
Saturday, November 5, AM
Continuing Education: This presentation qualifies for:
Pain Management CEs Social Work Ethic CEs N/A
AUDIO VISUAL INFORMATION:
Check all that apply:
LCD Projector Desktop Speakers (for video and music)
Internet (for presenter use) Internet (for participant use)
**You MUST provide your own laptop** My laptop is a: MAC PC
Presenter #1 Contact & Benefit Information:
Presenter Name: / Email Address: / License / Certification:
Agency / Affiliation: / Telephone:
▪Home:
▪Cell: / Degrees:
Mailing Address:
Presenter Benefits: Please check one.
VOLUNTEER / FREE REGISTRATION:
▪I am willing to donate my time to present a breakout session in exchange for free conference registration (for remaining breakout sessions). I will register online for the sessions I wish to attend.
▪Pending CE application approval, I will be eligible for CE credits (3x the contact hours) for my presentation.
COMPENSATION:
▪I would like the compensation fee of $100 for my presentation OR $50 if I am one of 2 presenters. I understand this excludes me from attending any breakout sessions or other conference activities.
▪Pending CE application approval, I will be eligible for CE credits (3x the contact hours) for my presentation.
Terms and Conditions:
I understand and agree to the Presenter Benefits listed above.
I understand and agree that I must submit my presentation and associated materials by October 1, 2016.
I understand and agree that if I am no longer available to present at the 2015 MASSW Conference, I will notify Laura Milner ( or by July 31, 2016. If I cancel after July 31, 2016, I understand that I am responsible for finding another individual to deliver my presentation.
Signature / Electronic Signature: / Date:
Presenter #2 Contact & Benefit Information:
Presenter Name: / Email Address: / License / Certification:
Agency / Affiliation: / Telephone:
▪Home:
▪Cell: / Degrees:
Mailing Address:
Presenter Benefits: Please check one.
VOLUNTEER / FREE REGISTRATION:
▪I am willing to donate my time to present a breakout session in exchange for free conference registration (for remaining breakout sessions). I will register online for the sessions I wish to attend.
▪Pending CE application approval, I will be eligible for CE credits (3x the contact hours) for my presentation.
COMPENSATION:
▪I would like the compensation fee of $100 for my presentation OR $50 if I am one of 2 presenters. I understand this excludes me from attending any breakout sessions or other conference activities.
▪Pending CE application approval, I will be eligible for CE credits (3x the contact hours) for my presentation.
Terms and Conditions:
I understand and agree to the Presenter Benefits listed above.
I understand and agree that I must submit my presentation and associated materials by October 1, 2016.
I understand and agree that if I am no longer available to present at the 2015 MASSW Conference, I will notify Laura Milner ( or by July 31, 2016. If I cancel after July 31, 2016, I understand that I am responsible for finding another individual to deliver my presentation.
Signature / Electronic Signature: / Date:

*****Please note that only two presenters per workshop are eligible to receive free conference registration or compensation fee. Additional presenters will be responsible for their conference fees, if attending.

2016 CE APPLICATION FORM
Conference Application Individual Workshop / Breakout Description
Workshop Title:
Conference Provider / Sponsor: Michigan Association of School Social Workers
Workshop Description:
Number of Times Presented: 1 / Time: 1.5 hrs 3.0 hrs
Presenters Names & Credentials:
OBJECTIVES
  • List learner’s objectives in measureable and behavioral terms
  • List three per every one hour of workshop time.

CONTENT
  • Provide a presentation outline orcontent description
  • Do not restate the objectives.

COURSE CONTENT CATEGORIES
  • Provide content number(s) from this list for each objective
1.Theories and concepts of human behavior in the social environment
2.Social work practice, knowledge and skills
3.Social work research, program evaluation, or practice evaluation
4.Social work agency management or administration
5.Development, evaluation, and /or implementation of social policy
6.Social work ethics standards of professional practice-must be a licensed SW
7.Pain must address physical pain
BIBLIOGRAPHY REFERENCES
  • List three relevant publications that were published within the last five years.
  • Use APA format.
  • Only list three for the entire workshop

PRESENTER(S) BIOGRAPHICAL SKETCH:
  • Include Name, Credentials, and Place of Employment
  • Include experience as it relates to this presentation
/
  • Presenter 1:
  • Presenter 2:

****BE SURE TO ATTACH a 1-2 page RESUMEfor each presenter ALONG WITH THIS APPLICATION****

2016 MASSW Workshop Application Form 1