2009 International Child and Youth Care Conference

Company/Organization/Agency:

Address: City:

State/Province/Country: Zip:

Phone/Fax: Email:

Co-presenters

Name: Name:

*The individual or group occupying the space and designated as the main contact is responsible for payment of audiovisual, food and beverage and all incidental expenses that occur on site during the workshop.

Presentation Information

Workshop Title:

Presentation Type:

Language:

Billling Information (if different from Key Presenter)

Name: Title:

Company/Organization/Agency:

Address: City:

State/Province/Country: Zip:

Phone/Fax: Email:

Themes/Topics

Please identify the theme(s)/topic(s) in which you feel your session could be included
(check more than one when appropriate)

AAI - Anger and Aggression Issues
AAN - Abuse and Neglect
ADO - Adoption
AIS - Attachment Issues
APP - Advocacy and Public Policy
CBC - Community-based care
CCD - Cultural Competency/Diverstiy
CSP - Child Sexual Predators on the Internet
CYH - Child and Youth Homelessness
ECC - Early Childhood Care and Education
EPI - Ethical Practice Issues
FCA - Foster Care
FCP - Family Centered Practice
GCA - Group Care
IHC - In-Home Care
ILI - Independent Living
JJU - Juvenile Justice
OBE - Obesity
PST - Professional Standards
RTI - Research and Training Initiatives
RTR - Residential Treatment
SAB - Substance Abuse
SED - Special Education
TPR - Teen Pregnancy

Questionnaire
Please give a short detailed description of your workshop. It should be one paragraph, four to six lines (maximum 90 words). In addition, you must provide three takeaways/benefits to attendees. You must also complete and submit responses to questions 1-7 of this questionnaire as well as all the information requested in this submission form.

Describe your Workshop:

1. Have you ever participated in an ICYCC Conference?
If yes, in what capacity?

2. Are you a member of the presenting organizations ACYCP, NSU or Provincial Child and
Youth Care Association?
If yes, which one?

3. What is the main goal and message of your proposed workshop? How do you believe it will benefit attendees of the ICYCC Conference?

4. How will you communicate the message of your workshop to the audience? (Please check all that apply)
Powerpoint Presentation
Discussion Groups
Interactive Sessions
Case Study
Handouts
Q&A Period
A/V
Expert Panelist
Other

5. At the end of your session, what will participants walk away with (new skills, resources, information, tools to engage in issue presented, etc.)?

6. Have you conducted the proposed workshop before?

If yes, how many times, where and for what type of audience?

If no, provide a brief description of your public speaking experience and your expertise with the proposed topic.

List a minimum of two (2) references

Name:

Phone:

Email:

Name:

Phone:

Email:

Name:

Phone:

Email:

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