Course Submission Form - Home Health Section of APTA

Course Submission Form

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If you are interested in proposing a course for hosting or co-sponsorship by the Home Health Section, please submit the following application form.

Be sure to review the instructions and criteria prior to submitting an application.

Hints are available for some fields below by allowing your cursor to hover over the field title.

Primary Presenter Information

Presenter Name *Name of primary presenter.
Company Name
Will the company be co-sponsoring the presentation? *Does the company intend to co-sponsor the course? If "no," it's assumed you are requesting that the Home Health Section sponsor entirely.	Yes No
Email Address
Phone Area Code
Phone
Address Line 1 *
Address Line 2
City
LocationState or Province
Zip/Postal Code
Co-Presenter Information (if applicable)

Co-Presenter Name
CoPresenter Email
Presentation Information

Title of Presentation *
Presentation Format *
Education Level *Select the appropriate education level for the course you are submitting.	Basic Intermediate Advanced
Relevant ObjectivesPlease provide a list of objectives that are specific and relevant to your submission (minimum of 2 objectives).
References *Please provide a list of current, relevant references to support this submission (minimum of three references). The references should provide sufficient evidence to support the submission content. Please consider the following: 1) Current citations (at least 50% of references are within the last 5 years); 2) Peer-reviewed articles; 3) Not only text book citations; 4) Not only handouts from other courses; 5) Not only web sites, unless it is a submission for strictly regulatory content; and 6) Clearly labels personal experiences or hypotheses vs. referenced scientific evidence.
Detailed Outline Attachment *Please attach a detailed outline of your proposed submission. If your submission is approved and will be offered for continuing education credit to attendees, you may be asked to provide a full copy of your submission for CE applications at a later time.
Speaker(s) Biography Attachment *Please attach a biography for each of your presenters in a single file. This biography will be used during the submission review process and for promoting the course if it is sponsored by the Section. If accepted, you may also be required to submit a CV for each presenter.

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