DDNA - Developmental Disabilities Nurses Association

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Online Speaker Application Form

Instructions:
You must complete this form in order for us to be able to offer continuing education for this topic. This will include entering speaker names, contact information, biographical sketch, presentation objectives (minimum of three) and a brief outline of subtopics. Please be prepared with all this information before beginning as you cannot finish your submission without completing all the fields. It is highly recommended that you print out a worksheet for gathering this information. Please click here to view and print the worksheet.

Fill in all required fields below and click "Continue". Required fields are denoted by an asterisk '*'.

* Presentation Title or Topic:

* Number of Speakers

Educational Activity Overview:

* Purpose Statement:

This statement should provide a brief description of the presentation to help individuals decide whether or not to attend. It should include who the activity is intended for, what knowledge, skills, etc. will be addressed, and how participants/clients will benefit from this activity. Click here to see a sample.

Behavioral Objectives:

Each presentation must have three behavioral objectives with supporting brief topic outline and learning method. Please complete the following information for each objective. Click here to see a sample.

Behavioral objective 1:

* Objective 1:
Outline of content related to objective 1. (Type in up to 8 topics):
* Topic 1
Topic 2
Topic 3
Topic 4
Topic 5
Topic 6
Topic 7
Topic 8
* Time frame (how long you will spend on content for objective 1:: minutes

Teaching methods that will be used to address objective 1:
: (hold down Ctrl key to select multiple teaching methods)

Behavioral objective 2:

* Objective 2:
Outline of content related to objective 1. (Type in up to 8 topics):
* Topic 1
Topic 2
Topic 3
Topic 4
Topic 5
Topic 6
Topic 7
Topic 8
* Time frame (how long you will spend on content for objective 2):: minutes

Teaching methods that will be used to address objective 2:
: (hold down Ctrl key to select multiple teaching methods)

Behavioral objective 3:

* Objective 3:
Outline of content related to objective 1. (Type in up to 8 topics):
* Topic 1
Topic 2
Topic 3
Topic 4
Topic 5
Topic 6
Topic 7
Topic 8
* Time frame (how long you will spend on content for objective 3):: minutes

Teaching methods that will be used to address objective 3:
: (hold down Ctrl key to select multiple teaching methods)

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