APTA Pediatrics Professional Development Event Proposal Form

APTA Pediatrics is always seeking to meet the educational needs of our membership. This form may be used by anyone seeking to present a course or webinar through APTA Pediatrics, from courses with multiple sessions and handouts that offers CEUs to 30-minute informational webinars. If you have a professional development event proposal idea, please complete this form for review by the Professional Development Team. If you are unsure of anything listed below, please leave blank; a member of the Professional Development Team will follow up by email with any questions.

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)