APTA Pediatrics Professional Development Event Proposal Form

Interested in presenting a course or webinar through APTA Pediatrics? Please complete this form to share your professional development ideas - from 30-minute informational webinars to courses with multiple sessions. Our Professional Development Team will review your proposal and follow up with you via email.

Contact Name *

Company

Phone

Email Address *

Course Proposal Type

Proposed Course Title *

Course Dates (if known)

Targeted Level of Participants' Baseline Knowledge

Proposed Course Format *

Audience

PT
PTA
Student

Present Course for CEUs?

Proposed Number of Hours

Course Description:

Speaker Name(s), Credentials, and max 50-word Bio(s):

Specific outcome objectives (written to reflect the appropriate levels of Bloom's Taxonomy for the target participant audience ): *

Proposed cost/budget?

Suggested date to open/close registration

If you have a link to a completed recording, please provide it here; if not, APTA Pediatrics can work with you to record

If you have a suggestion for pricing, please share here:

Member Price (please indicate a dollar amount; it can be free if you choose):
Non Member Price (please indicate a dollar amount; it can be free if you choose):

Make accessible only to APTA Pediatrics Members

Reflects the language and content of the Guide to Physical Therapist Practice and the International Classification of Functioning, Disability, and Health

Reflects the principles of evidence-based practice and includes a list of primary research articles and other scientific references as appropriate to support the educational content

Includes methods to evaluate a participant's attainment of the specified learning outcomes.

Specifically discloses any potential financial gain on the part of the presenter(s)

Upload Speaker Photo in JPG format (optional)