2025 NECHA/NYSCHA Co-Presenters


  1. You will be asked to attach Co-Presenter Bio/Disclosure Form before submitting your proposal. These documents should be attached in Word format, not PDF.
  2. All speakers are required to submit a copy of their curriculum vitae/resume (below).



Required fields are indicated by a red asterisk“*"

General Information

The title of the proposed program should reflect the content of that program. While cute titles may sound clever, they tend to detract from the professionalism of the conference and make it harder to determine what will be presented.



Co-Presenter Bio and Disclosure Form

Complete the following fields for the Primary Presenter.


Note: All disclosures that are determined by the ACHA/NECHA Program Planning Committee to be relevant relationships will be shared with the participants/learners in meeting materials and prior to the start of the educational activity.

As you would list them after your name (e.g. PhD, CHES)

List your completed academic degree(s), major or specialty area, and graduation year


Example: PhD; Clinical psychology; 2000


Co-Presenter Qualifications

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.

As you prepare your bio statement, please do not put “See CV” or other attachment. Consider the following when preparing your response:


  • Clearly state your content expertise related to the topic of your presentation.
  • Include relevant academic appointments, involvement in professional organizations, and/or awards/honors received.
  • Specify the number of years you’ve been working on the program initiative, topic area, or specialty.
  • Describe your involvement in implementation of research, initiative, topic area, or specialty.
  • Indicate whether you have presented on this topic before.


Example: I have been working as a Psychologist in our Counseling Center for five years. My dissertation was on identity development among trans students. In my current role I primarily work with trans students, and I serve as the Co-Investigator of this study. I have presented about this research on-campus and at other national conferences.


I am qualified to give this specific presentation because:


Conflict of Interest (COI) Disclosure

Policy

ACHA/NECHA 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.


All faculty/presenters/authors/planners are required to disclose all financial relationships with any ineligible companies (defined below) that you have had over the past 24 months, regardless of the amount and regardless of whether you view the financial relationships as relevant to the education. The Program Coordinator will identify and mitigate, as appropriate, any relevant relationships and the presence or absence of relevant financial relationships for all persons in control of content will be disclosed to the participants/learners before the learner engages in the education.


Please note: The identification of financial relationships with ineligible companies does not necessarily mean that you are unable to participate in the planning and implementation of this educational activity. Rather, the accreditation standards require that relevant financial relationships are mitigated before you assume your role in this activity.

Conflict of Interest Attestation*

I have read, fully understand, and agree to adhere to the Conflict of Interest Disclosure Guidelines as outlined above and below.

Disclosure of Relationships

Definitions


Ineligible Company: The ACCME defines an ineligible company as any entity whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. For specific examples of ineligible companies visit www.accme.org/standards


Relevant Relationship, as defined by ACCME and ANCC, are relationships with an ineligible company, if the products or services of the ineligible company are related to the content of the educational activity. Individual stocks and stock options MUST be disclosed; diversified mutual funds do not need to be disclosed. Research funding from ineligible companies MUST be disclosed by the principal or named investigator even if that individual’s institution receives the research grant and manages the funds.


Nature of the Financial Relationship: Examples of financial relationships include employee, researcher, consultant, advisor, speaker, independent contractor (including contracted research), royalties or patent beneficiary, executive role, and ownership interest. Individual stocks and stock options should be disclosed; diversified mutual funds do not need to be disclosed. Research funding from ineligible companies should be disclosed by the principal or named investigator even if that individual’s institution receives the research grant and manages the funds.

COI Disclosure*

During the past 24 months have you had a financial, professional or personal relationship (including self-employment and sole proprietorship) with a company (as defined above).

If you have a financial relationship with a company but aren’t sure whether it fits the definition above, it’s best to check yes and include the information.

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

Has the relationship(s) ended?*

If you've listed more than one relationship, please list which relationship has ended, if applicable.

Content Related to Company(s)*

If you've listed more than one company, please list which company the content is related to, if applicable.

Off-Label Use of Drugs*

Will your presentation include discussion of off-label, experimental, and/or investigational use of drugs, devices, medical procedures, or interventions?

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.

1. Co-Presenter Bio/Disclosure Form(s)* Attach a Co-Presenter Bio/Disclosure Form for each co-presenter. The document name should begin with the presenter’s LAST NAME. The forms must be signed and dated and submitted as Word documents.


2.Curriculum vitae/resume

Drag and drop files here or