Scshsa Annual Fatherhood/Male Involvement Training Conference: May 4-6, 2017

SCSHSA ANNUAL FATHERHOOD/MALE INVOLVEMENT TRAINING CONFERENCE: MAY 4-6, 2017 CALL FOR PAPERS APPLICATION

Please complete and return this two-page form by MARCH 17, 2017; save changes and email as an attachment to [email protected] OR mail to: SCSHSA Fatherhood/Male Involvement Conference Coordinator, PO Box 7562, North Augusta, SC 29841

Presenter Information: Name of Lead Presenter: Title: Employer/Business Mailing Address: Email Address Website:

Co-Presenter Information (if applicable): Co-Presenter Name: NONE Title: Employer/Business Name: Mailing Address: Email Address: Website: Phone Number (please include area code):

What is the title of your workshop or seminar? (4 words or less):

Description of Presentation (60 words or less):

Target Group:

Description of Handouts Provided by Presenter:

Training Topics (please check ALL that apply): ADMINISTRATION/MANAGEMENT EARLY CHILDHOOD DEVELOPMENT FAMILY/COMMUNITY PARTNERSHIPS for FAMILY ADVOCATES HEALTH SERVICES – circle one: health mental health nutrition dental DISABILITIES SERVICES ADMINISTRATIVE SUPPORT SERVICES PARENT/MALE INVOLVEMENT for PARENTS TRANSPORTATION FAMILY LITERACY OTHER: Please explain:

Training Categories (please check ALL that apply): 0-3 (EHS) 3-5 (HS) Migrant/Seasonal Tribal EHS-Child Care Partnerships

1 Type of Session (please check ONE): WORKSHOP (1.5 hours) If you need additional time, you will need to submit another form for Part 2 for 1.5 hours.

Preferred day(s)/time(s): Please select all that would work for your schedule. We are trying to fill each room, during each training time, so please select a couple of choices if possible.

Thursday Morning Thursday Morning- Thursday Afternoon Thursday Afternoon Friday Morning

Are you willing to present this workshop twice: YES NO

Primary Language of Presentation (please select ONE): English Spanish

Suggested Number of Participants (please check ONE): 0-40 41-75 76+

Preferred Room Set (please check ONE): Theatre/Auditorium Rounds

Audio/visual (LED projectors only: laptops will not be provided) will be provided by SCSHSA. Any additional request must have prior approval.

Lead Presenter ONLY: Please provide a brief description of your company or consultant services, including contact information you want conference attendees to have, for the “Presenter Index”:

Once your proposal has been reviewed, a letter or email of notification will be forwarded to the LEAD PRESENTER. SCSHSA will provide a complementary registration for the LEAD PRESENTER and ONE (1) CO-PRESENTER. Facilitators will be arranged for each workshop.