Enter information about a presentation you gave
as part of a larger conference, symposium or workshop. For example, let's say
you presented at a conference sponsored by another Knight ADRC. You would enter
information on both the conference and your own particular presentation in
the boxes below.
If you gave more than one presentation at the same conference, please
submit this form twice with the appropriate changes. The easiest way to do
this is use the back key on your browser after you submit the first
presentation. The information you entered should still be preserved and
then you can edit it for the second submission. This also holds true for
events that included more than one of our faculty members.
Important fields are in RED.
Leave blank those fields
that do not apply or for which information is not available. Contact
Tom Meuser, Education Director,
if you have questions.
Type of Event:
Title of Conference/Event:
Primary Sponsoring Organization:
Your Contact Person for the Conference:
(First Last, Affiliation)
Location of Event:
(City, State and/or Country)
Regarding the individual presentation:
Last Name of Presenter:
Date of Presentation: (e.g., 4/2/01)
Title of Presentation:
Duration of Presentation (in hours):
(e.g., 1.25 hours)
Approximate Number in Attendance:
Skip OPTIONAL ITEMS
and go to Comments Box and SUBMIT Button
estimate the % of individuals present
from the following categories:
(% of total audience)
Lay / Caregiver
(Together must add to 100%)
Other Health Profession
Did this event meet its educational
and/or outreach goals?
Were evaluation forms distributed?
Were NOT Distributed
If Yes, what was the average overall
(e.g., 4.23 on a 1-5 Scale; 5 = Excellent)
Were Knight ADRC funds used to support this event?
Yes Clinical Core
Yes Other Knight ADRC/HASD
You are limited to 255 characters in this box. Feel free to use
abbreviations. If you have more to say, e-mail your comments with a
reference to this enter to Tom
Meuser, Education Director.