Webinar Proposal Form

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Webinar Title

Webinar Title(Required)

Lead Presenter

Name(Required)

First Last

Institution/Company(Required)

Education(Required)

Professional Experience(Required)

Position/Title(s)(Required)

Lead Presenter Photo(Required)

Accepted file types: jpg, gif, png, Max. file size: 5 MB.

Are you a Closing The Gap Solutions Member?

yes

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Mobile Phone

Fax

Email(Required)

Website URL

Additional Presenters

How many additional presenters will there be?(Required)

Additional Presenter 1

Name(Required)

Email(Required)

Phone(Required)

Education(Required)

Institution(Required)

Position(Required)

Mailing Address(Required)

Photo(Required)

Accepted file types: jpg, gif, png, Max. file size: 5 MB.

Are you a Closing The Gap Solutions Member?

yes

Professional Experience(Required)

Financial Disclosure

Presenters are required to disclose whether or not they have relevant financial relationship(s) or, relevant non fictional relationship(s), and must list anything that could be interpreted as making you bias on the presentation content.

Does this presenter have any relationships necessary to disclose?(Required)

Yes

Financial Disclosure Details(Required)

Additional Presenter 2

Name(Required)

Email(Required)

Phone(Required)

Education(Required)

Institution(Required)

Position(Required)

Mailing Address(Required)

Photo(Required)

Accepted file types: jpg, gif, png, Max. file size: 5 MB.

Are you a Closing The Gap Solutions Member?

yes

Professional Experience(Required)

Financial Disclosure

Does this presenter have any relationships necessary to disclose?(Required)

Yes

Financial Disclosure Details(Required)

Additional Presenter 3

Name(Required)

Email(Required)

Phone(Required)

Education(Required)

Insitution(Required)

Position(Required)

Mailing Address(Required)

Photo(Required)

Accepted file types: jpg, gif, png, Max. file size: 5 MB.

Are you a Closing The Gap Solutions Member?

yes

Professional Experience(Required)

Details

Have you or any co-presenter(s) presented this webinar before?(Required)

Yes

Please indicate when and where.(Required)

Will you or any co-presenter(s) submit this proposal to or present this proposal at any other national conference or online for another entity?(Required)

Yes

If yes, please indicate when and where.(Required)

The content of this session is supported by evidence and references are provided.(Required)

Yes

This webinar includes quantitative performance data(Required)

Yes

Length of session(Required)

1 hour

1hr 30mins

Financial Disclosure

Presenters are required to disclose whether or not they have a relevant financial relationship(s) or, relevant non-financial relationship(s), and must list anything that could be interpreted as making you bias on the presentation content.

Do you have any relationships necessary to disclose?(Required)

Yes

Financial Disclosure Details(Required)

Description

If this is a product demonstration, is the product available for purchase at this time?

Yes

N/A

Webinar sophistication level(Required)

Beginner

Intermediate

Advanced

N/A

Primary topic of webinar(Required)

accessibility & UDL

assessment & IEPs

augmentative and alternative communication (AAC)

autism spectrum disorder (ASD)

blind / low vision

deaf and hard of hearing

early childhood development

instruction, literacy & inclusion

leadership, policy & implementation

mathematics

mobility, mounting, seating & positioning

research

transition, employment & vocational rehab

Learning Outcomes – As a result of this activity, participants will be able to:

(Check the CEU area of the AAC Institute website for appropriate verbs to be used for learning outcomes statements. www.aacinstitute.org)

Required

Learning Outcomes(Required)

Target Audience(Required)

AT Specialist

Autism Specialist

Consultant

Deaf / HOH

Educator

Family Member / Caregiver

Healthcare Adminstration

K-12 Administratioin

Occupational Therapist

Paraprofessional

Physical Therapist

Special Educator

Speech Language Pathologist

Teacher of the Visually Impaired

University Professor / Personnel

Vision Impairment Specialist

(Please be specific)

Age Span Addressed(Required)

infant / toddler

preschool

kindergarten-grade 6

grades 7-12

adult

(Please be specific)

Disability Type Addressed(Required)

cognitive disabilities

hearing impaired / deaf

learning disabilities

physical disabilities

speech / language disabilities

vision impaired / blind

behavioral / emotional disorders

traumatic brain injury

(Please be specific)

In addition to offering IACET CEUs, Closing The Gap is a Registered Provider of Professional Learning and Education CEs (RPPLE) for the Academy for Certification of Vision Rehabilitation and Education Professionals (ACVREP). In order to register a CE activity, we must identify whether or not your workshop is applicable to the ACVREP Content Classification Codes identified below.

Academy for Certification of Vision Rehabilitation and Education Professionals (ACVREP) Questionnaire/Instructions(Required)

the visual system and vision loss

psychosocial aspects of visual impairment

the auditory system and hearing loss

professionalism in vision rehabilitation and education

professional information

aging and vision loss

individuals who are visually impaired with additional disabilities

sensory motor functioning

human growth and development over the lifespan

assessment of persons with visual impairment and their environments

instructional methods

program development,administration, and supervision

communication, team-building, consumerism, cultural diversity, and working with families

assistive technology for people with vision loss

not applicable

(Check all that apply, if none of these apply, select "not applicable")

Session Abstract

Please give a 300-500 word abstract of your session.(Required)

Session Summary

Please give a brief summary of your session with up to 125 words. This summary should be written in the future tense, using person-first language, concisely stating session sequence and scope, and highlighting concrete examples and products. This summary must be congruent with the content of the actual session. It will be used by participants as the basis for attending and evaluating the session.(Required)

Multiple Choice Options(Required)

Correct Answer(Required)

The Bottle Station: Empowering Independence by Ending Falling Bottles

Webinar Proposal Form