2019 ACHA Annual Meeting Call for Programs

This form must be completed in one sitting. Please first prepare your Program Submission Form per the instructions above.

SUBMIT THIS FORM ONLY ONCE. If you have additions or changes to your proposal after it has been submitted, please contact Katie Francavilla at kfrancavilla@acha.org.

Required fields are indicated by a red asterisk“*”

I understand and agree to adhere to the General Policies for Presenters, including the proper or required content of slides, and will share these policies with my co-presenters if applicable. (Refer to link in instructions above.)

Choose the time length most appropriate for your session's topic, objectives, and content. The length of the session does not reflect on its potential quality and likelihood for selection.

*Note that we may not be able to accommodate your preference.

Provide a short (75 words), descriptive abstract of your presentation that will be inserted VERBATIM in conference materials. Please be concise and clear with your description. If your presentation will address original research, please specify.

Does your program address diversity? If so, describe how it addresses diversity based on the following aspects: age; gender identity, including transgender; marital status; physical size; psychological/physical/learning disability; race/ethnicity; religious, spiritual, or cultural identify; sex; sexual orientation; socioeconomic status; military veteran status. (Not a prerequisite for program selection.)

Will your presentation include content related to pharmacology? Check yes or no and, if yes, please ensure that your objectives and content (below) validate the pharmacology component.

If yes, please select the estimated percentage of session content related to pharmacology.

Who is the expected learner for your program? (Check all that apply.)

If your expected learners includes others, please specify.

When there is a gap between what the professional is currently doing or accomplishing compared to what is desired/achievable on the basis of current professional knowledge, there is a professional practice gap.

The goal of a strong educational session is to change participants’ knowledge, skill, or performance in an effort to eliminate the practice gap – ultimately making a positive change in student health outcomes. With this in mind, complete the following questions so that program planners have a clear understanding of how the information presented in your session will change participants’ knowledge, skills, or performance.

Briefly describe the practice gap related to your session topic.

This presentation will address a gap in:

(e.g., Participants don't have the information and/or skills they need to advocate for a tobacco-free campus.)

(e.g., Participants will have the information and/or skills needed to advocate for a tobacco-free campus.)

Describe what the learner will be able to do as a result of participating in this session.

Important: Refer to the Instructions for Types of Submissions and Writing Learning Objectives and Content before completing this section. (Refer to links in instructions at the top of the page.)

Each Learning Objective should complete the phrase, "After this session, attendees should be able to..."

Begin each objective with one of the following measurable verbs: Describe, Explain, Identify, Discuss, Compare, Define, Differentiate, List.

End each sentence with a period.

Make a separate objective for each action. Example: Define sleep deprivation and the consequences. These are two separate actions and should be split into two objectives as follows:
1. Define sleep deprivation.
2. List the consequences of sleep deprivation.

Note: If the presentation will address mental health issues, please ensure this is reflected in the learning objectives.

Content is the information needed to meet each learning objective.
Objective: Define sleep deprivation.
Content: degrees of sleep, quantity of sleep, quality of sleep, circadian factors

Content should be in the form of a brief list, separated by commas, and not be a restatement of the objective.

After this session, attendees should be able to:

List specifics that will be covered under this objective.

What percentage of the total session time will this objective take?

List all presenters (first and last name) who may contribute to this objective.

What learning method will be used for this objective? (e.g., Lecture and PowerPoint, Lecture and Q&A, Group Discussion, Panel Presentation, Role Play, Small Group Activities, etc.)

• Information available from organizations’ website(s) (organization must use current available evidence; may be published or unpublished content; examples: Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, National Institutes of Health)
• Peer-reviewed journal(s)/resource(s)
• Clinical guidelines, public health practice guidelines (example: guidelines.gov)
• Expert resource(s) (example: individual or educational institution’s book, article, website)
• Textbooks
• Best practices or new and emerging issues

If applicable, provide specific website address, journal volume number, etc., so that the data can be easily accessed by program planners.

Content for this educational activity was based on:

Complete the following fields for the Primary Presenter.

(as you would list them after your name -- e.g., MPH, BSN, CHES)

For student eligibility, refer to link in instructions above.

I intend to register for the ACHA Annual Meeting as a:

Please provide complete information in this section, as presenter qualifications factor heavily in the decision-making process of the program planners and continuing education reviewers.

List your completed academic degree(s), institution where the degree was earned, and major or specialty area. (e.g., PhD, ABC University, clinical psychology). Also list current professional certifications (e.g., CHES, APN, LPC).

(Example: I have been the principal or co-principal of multiple federally-funded grants focusing on the epidemiology of drug abuse, HIV prevention, and co-occurring mental and drug use disorders. Among my scientific interests has been the development of strategies for preventing HIV and STDs in out-of-treatment drug users.)

Bio statement must state content expertise. Please submit your biographical qualification statement below. Also include any relevant academic appointments, involvement in professional organizations, and/or awards/honors received. Limit 75 words.

I am qualified to give this specific presentation because:

ACHA is obligated to the organizations that grant us CE accreditation/approval to ensure that all educational activities are developed and presented with independence, objectivity, and scientific rigor. It is our responsibility to ensure that they are free from promotion of specific goods or services, and that they are free from actual or potential bias.

I have read, fully understand, and agree to adhere to the Conflict of Interest Disclosure Guidelines. (Refer to the link in the instructions at the top of the page.)

Required Disclosure: During the past 12 months have you, or your spouse or partner had a financial, professional or personal relationship (including self-employment and sole proprietorship) with a commercial interest (as defined in the Conflict of Interest Disclosure Guidelines).

If you answered yes above, list the full company name and the specific relationship(s) below.

By typing my name below, I am providing my electronic signature indicating that all the information entered in this Program Submission Form is accurate. I further attest that I will not promote any products, goods, or services, or bias the educational activity in any manner.

If you have additional co-presenters (other than yourself), check "Yes" and enter their information below. You will be responsible for sending them the link to complete their bio/disclosure forms and for making sure they do so immediately after you submit your program proposal.

If you do not have additional co-presenters, check "No" and skip to the bottom of the form.

If you have more presenters in addition to yourself as the primary presenter, and the 4 additional co-presenters listed above, check yes below and forward the co-presenter link to the additional presenters.

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