Lca Conference Call for Programs

LCA CONFERENCE CALL FOR PROGRAMS

All proposals must be received in the LCA office by April 1. Forms may be completed online at or mailed to 353 Leo, Shreveport, LA 71105.

Please answer all questions completely.

All presenters must be members of LCA unless membership has been waived by the LCA leadership when this application is submitted.

Information About the Presenter(s):

Lead Presenter: ______

Mailing Address: ______(include city, state, zip)

E-mail Address:______

Credentials:______Degree:______(Lead presenter must have a masters or above in a mental health field)

Position and Place of Employment: ______

______

Additional Presenters: The number of total presenters must not exceed four. Masters Level Candidate students may join their professor in his/her presentation but not be the lead presenter.

Presenter 2:

Name:______

Credentials: ______Degree:______

Position and Place of Employment: (If additional presenter is a graduate student include the institution)______

Presenter 3:

Name:______

Credentials: ______Degree:______

Position and Place of Employment: (If additional presenter is a graduate student include the institution)______

Presenter 4:

Name:______

Credentials: ______Degree:______

Position and Place of Employment: (If additional presenter is a graduate student include the institution)______

Have you presented at an LCA Conference is the past three years? ______yes ______No. If yes:

Year______Title of Presentation: ______

If your presentation is selected do you or any of your co-presenters have any conflicts for any day during the conference. Presentations will be scheduled based on the information provided here. Once presentations are scheduled there can be no changes.

______yes ______no If yes, please explain: ______

Information About the Presentation:

Title of the Presentation: ______

______

Session Length: _____1.5 ____3.0

Target Audience: ______

Program Description: Limit to 75 words or less. This description will be used in the conference description and should encourage conference participants to attend your presentation. ______

______

Program Outline or Summary: Please be detailed as the reviewers will use this to determine selections

______

Documentation of Expertise: Please supply information that addresses your interest, knowledge, and/or expertise in the area/subject matter of your presentation: ______

______

Content Area to be Addressed

____Counseling Therapy____Theoretical Knowledge of Marriage/Family Therapy

____Human Growth and Development____ Critical Knowledge of Marriage/Family Therapy

____ Social and Cultural Foundation____ Assessment/Treatment in Marriage/Family Therapy

____The Helping Relationship____Individual, Couple and Family Development

____ Group Dynamics____Professional Development and Ethics in Marriage and

Family Therapy

____Lifestyle and Career Development____Research in Marriage and Family Therapy

____ Appraisal of Individuals____ Supervision in Marriage and Family Therapy

____ Research and Evaluation

____ Professional Orientation

____Chemical Dependency ____ Other ______

Continuing Education for Marriage and Family Therapist: Please sign.

Continuing education hours will be requested from Louisiana Association for Marriage and Family Therapy. LAMFC will review selected proposals to determine educational offerings with content related to Marriage and Family Therapy domains. An essential requirement is that at least one presenter be someone with master’s level or above education and trained in Marriage and Family Therapy or another appropriate mental health field with the requisite education, training, and experience in relational systems clinical practice, and in the area to be presented in order to be qualified to teach and present the topic of review. A master’s degree in social work meets their requirements. LAMFT requires that the lead presenter sign the attestation below for their records. If you meet these educational requirements, please sign below in the event that your program is selected for LAMFT credit.

LAMFT Attestation

I/We (print name) ______attest that I/we have the requisite education, training, and/or experience in relational systems clinical practice (i.e. marriage and family therapy; marriage and family therapy ethics; etc) to be qualified to teach and present on the topic under review. MFT (specifics) ethics presenters must use/discuss the AAMFT Code of Ethics.

______

Sole/Lead Presenter’s Signature Date

Level: Basic_____Intermediate _____Advanced______Basic: Session participants do not need prior knowledge of content area; these workshops are for participants who want to expand knowledge, foundation and skills. Intermediate: Session participants need basic or very little knowledge of content area. These workshops are for participants who want to expand their knowledge, foundation and skills. Advanced: Session participants should have substantial knowledge and experience in content area; these workshops are for participants who have had years of experience in content areas such as in therapeutic practice or research.

PRESENTER CONTRACT

On my (and my co-presenters’) behalf, should this proposal be accepted, I (we) agree that:

All the information submitted on this proposal is accurate to the best of my(our) knowledge.
All presenters are members of LCA (unless membership has been waived by the LCA Leadership)
Presenters will agree to submit their handouts and/or Power Point to the LCA APP before the beginning of the conference. Conference Participants look for these handouts and are disappointed when they are not available. (Information concerning this will be included in the Letter of Acceptance).
Presenters will agree to bring 100 hard copy handouts to the actual presentation.
All presenters will register for the conference. Registration may be for only the day of the presentation. Presenters will check in and receive their packet and badge prior to the time of their session.
The individual signing this contract agrees to receive all conference correspondence and accepts responsibility for conveying conference-related information to co-presenters.
Appropriate “Releases of Confidential Information” have been obtained for all client materials that will be used or presented as part of this program. The responsibility of client confidentiality rests with the presenter(s).
Presenter(s) will be responsible for audio-visual equipment needed for the presentation. Any equipment rented by the presenter is the sole responsibility of the presenter(s).
Individuals submitting or included in this proposal have agreed to present at the LCA conference during the time and date assigned to the presentation.
If for any reason presenters must cancel the presentation, I agree to notify LCA immediately using the contact information provided. Cancelation of a presentation should occur before the beginning of the LCA Conference unless an emergency occurs.

______Signature of the Lead Presenter Date