Proposal

NEW JERSEY OCCUPATIONAL THERAPY ASSOCIATION

2008 CONFERENCE PROPOSAL FORM

Primary Speaker Name/Credentials _____________________________________________ _________

Employer:__________________________________________________________ __________

Address:_____________________________ __ ________________________________________________

___________________________________________________________________ ___________

Phone:__________________________________Email:______________________________________________

Additional Speaker(s): (include credentials and employer) _________ _ __________________________

___________________________________________________________________ ___________________

______________________________________________________________________________________

Content Area:

Phys Disabilities:________ Mental Health:________ Pediatrics:________

Geriatrics: ________ Home Health: ________ Education:________

Administration: ________ General Practice:______

Practice Level: Basic: _______ Intermediate:_________ Advanced: _______

Session Length: Short Course – 1.5 Hours: ________

Workshop – 3 hours: ________

Poster session: ________

A/V requirements: LCD:________ Overhead:________ VCR:________

Other:__________________________________________________________________

Any other special requirements:________________________________________________________________

Title of Session (must be 10 words or less):_______________________________________________________

____________________________________________________________________________________________

PROPOSAL ABSTRACT: (30 words or less)

Please provide a succinct, clear overview of the session to be printed in the conference program. This section is not applicable

for poster sessions.

____________________________________________________________________________________________

COURSE OBJECTIVES:

List specific educational outcomes participants will achieve through participation in the session.

____________________________________________________________________________________________

PROGRAM DESCRIPTION:

Describe and outline the purpose and the content of the presentation. It should state the nature and scope of the topic(s) and

outline the problem(s) or issue(s). If applicable, it should include supporting reference citations.

____________________________________________________________________________________________

You will need to print this form and then fill it in. You can then either mail or scan and send

as an attachment via email.

SUBMIT BY May 15, 2008 TO:

Felicia Chew, MS, OTR/L

259 Ashton Drive

Gibbstown, NJ 08027

or electronically to: f.chew@njota.org