OSHA Annual Conference – Salem, OR – October 13-14, 2017
Presentation Proposal
Submission deadline: April 17, 2017
Please fill out all sections and submit with individual financial disclosures form for each presenter. Materials may be submitted in Word or pdf format to .
The fillable forms can take unlimited text; you can copy and paste from a different document if you like.
I. Presenter Information
Please list names, titles, and affiliations as they should appear on the program, and in the desired order.First author name and education degree:
Affiliation:
Address:
Phone:
email:
Second author name and education degree:
Affiliation:
Address:
Phone:
email:
Third author name and education degree:
Affiliation:
Address:
Phone:
email:
You may attach an additional page if you have more than three presenters.
II. Presentation Format
Select the format for your presentation by checking the box.3 hours presentation (Saturday morning)
1.5 hour presentation (Saturday afternoon)
Poster presentation (Friday late afternoon)
III. Proposal Focus
Check all applicable boxes.Discipline: / Audiology / Speech Pathology / Other
Area: / Treatment / Assessment / Professional Issues
Research / Other
Population: / Infant/Toddler / Preschool / School Age/Adolescent
Adult
IV. Proposal Details
Please fill in each section.Title of presentation.
Abstract. 50 words summarizing the major aspects of your proposal, to be published in the conference program.
Presenter List (to be included with abstract in conference program). Please include names and professional credentials, and affiliations, in the order you wish them to be listed in the program.
Biographical sketches. Please include brief biographical information about each presenter (no more than 50 words per person).
Learning objectives. Include three learning objectives (see http://www.asha.org/ce/for-providers/Learner_outcomes/ for guidelines on writing learning objectives to meet continuing education requirements).
1.
2.
3.
Presentation level. Check the appropriate box.
Beginning Intermediate Advanced