The Call for Proposals – Fire Service Psychology Association

Primary Presenter/Applicant Information:

Name*

First Middle Last

Degree:*

OR Rank:

Address*

Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email Address:*

Are you an FSPA member?*

Yes

PRESENTER CV: Please attach a copy of the author’s curriculum vitae. Without this document, the application will be considered incomplete and your application will not be processed.*

Max. file size: 2 MB.

Identification: NAME/DEGREE/TITLE/AFFILIATION/ LOCATION (Example: Sally Smith, Ph.D., Director, Private Practice, Los Angeles, CA OR Battalion Chief John Doe, Health and Safety Officer, Modesto Fire Department, Modesto CA) Please type in your information so it is similar to the above example. What you type in the box below will be listed in all of the conference promotional materials.*

Presentation Abstract: Enter the abstract for your presentation in the space below, 50 WORD MAXIMUM. This description will be used in the Conference marketing materials and in the final program. ABSTRACT*

Presentation Syllabus / Summary:

Type or paste your syllabus describing your presentation in the space below, 350 WORD MAXIMUM Syllabus:*

Are you proposing a 20, 60 minute, or 90 minute presentation?*

20 minutes

60 minutes

90 minutes

Presentation Learning Level:*

Beginner (No CE Eligibility for Mental Health Providers/ Intended Audience Fire Service Personnel)

Intermediate

Advanced

What type of audience is your presentation geared for?*

Operations

Consultation

Assessment

Intervention

Presentation Learning Objectives:

Please provide three learning objectives for this presentation. If more than three are listed, the first three only will be used.
LEARNING OBJECTIVE EXAMPLES: Identify challenges to healthy intimate partner relationships including unpredictability of the nature of work. Explain the role of shift work on relationship dynamics

In writing your three learning objectives please use measurable terms such as: identify, describe, explain, discuss, and evaluate.

1. After attending this presentation participants will be able to:*

2. After attending this presentation participants will be able to:*

3. After attending this presentation participants will be able to:*

Method of Teaching:

1. What will be the take-home points that can be immediately used in practice?*

2. How will the presenter encourage discussion and interaction in your session.*

Participants:

I will be the only presenter for this workshop.*

Yes

If you are proposing a panel, are you including a member from a profession other than psychology or the fire service (example: politician or medical doctor)?*

Yes

How many presenters you want to include*

Additional Presenters (if applicable):

All information is required.

PRESENTER 2:

Name*

First Middle Last

Degree:*

OR Rank:

Address*

Address Line 1: Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Are they an FSPA member?*

Yes

CV Requirement: Please attach a copy of the presenter’s curriculum vitae. Without this document, the application will be considered incomplete and your application will not be processed.*

Max. file size: 2 MB.

PRESENTER 3:

Name*

First Middle Last

Degree:*

OR Rank:

Address*

Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Are they an FSPA member?*

Yes

• CV Requirement: Please attach a copy of the presenter’s curriculum vitae. Without this document, the application will be considered incomplete and your application will not be processed.*

Max. file size: 2 MB.

PRESENTER 4:

Name*

First Middle Last

Degree:*

OR Rank:

Address*

Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email Address*

Are they an FSPA member?

Yes

PRESENTER CV: Please attach a copy of the presenter’s curriculum vitae. Without this document, the application will be considered incomplete and your application will not be processed.

Max. file size: 2 MB.

Will your presentation require any other type of equipment in the presentation? (For example, fire apparatus, arson-crime scene investigation material, etc.)

Authorization - By submitting this proposal I agree to the following:

All of the information is true and complete. This application is a accurate representation of the information I am proposing to present at the FSPA conference.

I understand and agree to all of the instructions and rules.

I understand that, if my proposal is accepted, all presenters in my session will be required to register for the conference and will receive a reduced registration rate.

I give permission to FSPA to use all or part of my presentation for publicity purposes.

I agree that all presenters in my session will appear and deliver the presentation, if accepted.

I give permission to FSPA to edit my presentation title and/or abstract as necessary for publication purposes.

Unless otherwise agreed upon, I understand that I will not be paid to present my workshop(s) and I will not be reimbursed for any expenses.

I agree to provide electronic files of my handouts to FSPA by the deadline in the presenter contract.

I understand that if my proposal is incomplete it will not be reviewed by the program committee.

I understand that I will be responsible to provide a laptop if I wish to use PowerPoint during my presentation

NOTE: Primary presenter is responsible for notifying co-presenters of ALL presentation details. I agree with the above.

Name*

First

Date*

MM slash DD slash YYYY

SIGNATURE:*

Important Dates / Deadlines March 01, 2019 - Proposal Deadline May 15, 2019 - Notification of presentation acceptance or rejection sent via email to primary presenter. July 15, 2019- Speaker agreement letters mailed to all accepted presenters

SEND COMPLETED APPLICATIONS TO: INFO@FIREPSYCHOLOGY.ORG

* Facility will provide access to Audio/ Visual equipment such as audio speakers and microphones. If a panel discussion is approved, lapel microphones or standard microphones will be available on the table.

PROPOSAL APPLICATION

Fill out the details below

Primary Presenter/Applicant Information:

Presentation Syllabus / Summary:

Presentation Learning Objectives:

In writing your three learning objectives please use measurable terms such as: identify, describe, explain, discuss, and evaluate.

Method of Teaching:

Participants:

Additional Presenters (if applicable):

PRESENTER 2:

PRESENTER 3:

PRESENTER 4:

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