1 Introduction2 Lead Presenter Information3 Second Presenter Information4 Workshop Information5 Accreditation6 Deadline January 31st Thank you for applying to present a 75-minute workshop at our 37th Annual Conference, October 17-18 in Atlantic City. All content must be autism-specific and will undergo a clinical review. Two-part sessions are an option. A maximum of 2 presenters per workshop are permitted. Feel free to contact Education & Training Director, Elizabeth Neumann (eneumann@autismnj.org) to discuss a potential workshop or the conference in general (609.588.8200 x10045). Sincere thanks to our presenters for donating their time to share their expertise. This audience includes diverse professionals (the majority are school personnel and behavior analysts) and caregivers. Feedback stresses the need to focus on intervention and practical strategies as opposed to theory or background information. Social skills and challenging behavior are the most requested categories, and workshops on a specific skill or topic are preferable to overviews of broad concepts. Content may focus on a particular age group, subset of individuals, etc. and may address family or professional issues instead of intervention. Review the full application HERE before beginning; all of the questions and attachments are required for the CE boards and our event marketing. Please note: that link is only for previewing the questions. The actual application starts when you click NEXT below. If at any time you would like to save your form and complete it at a later date please click the ‘save and continue’ button at the bottom of the form and follow the directions on the next screen. First-time presenters with Autism New Jersey may only submit one application and must include a letter of reference addressing presenting skills and expertise in the topic to be discussed. Name* Dr.Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Suffix AffiliationEmail* Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home or Work Address*HomeWorkPhone*Phone Type*HomeMobileWorkBio:*Please provide brief biographical sketch that includes current position and affiliation, degrees earned (include field of study and conferring institution), other credentials and experience. Bios for approved workshops will be listed on our website.Please upload a copy of your resume or CV*Do you have any financial or nonfinancial disclosures?Examples of financial disclosures include royalties for a book on the workshop topic or employment by the publishing company. Nonfinancial disclosures include related board positions, affiliations, etc...) Yes Please list any disclosures below:Is this your first time presenting at the conference? Yes Letter of RecommendationFirst time presenters are required to upload a letter of recommendation. Letters of recommendation should refer to your presenting skills and expertise in the content to be discussed.Is there a second presenter Yes Name* Dr.Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Suffix AffiliationEmail Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home or Work Address*HomeWorkPhone*Phone Type*HomeMobileWorkBio:*Please provide brief biographical sketch that includes current position and affiliation, degrees earned (include field of study and conferring institution), other credentials and experience. Bios for approved workshops will be listed on our website.Please upload a copy of your resume or CV*Do you have any financial or nonfinancial disclosures?Examples of financial disclosures include royalties for a book on the workshop topic or employment by the publishing company. Nonfinancial disclosures include related board positions, affiliations, etc...) Yes Please list any disclosures below: Workshop Title*Please keep the title simple. Autism New Jersey Reserves the right to edit titles and descriptions.Workshop Duration*1 Part, 75 Minutes2 parts, 150 MinutesWorkshop LevelBasic: parent of newly diagnosed child, teacher new to autism etc.. Intermediate: parents and professionals with a general knowledge of autism and basic ABA strategies Advanced: experiences masters/doctoral-level cliniciansBasicIntermediateAdvancedAge Groups Select All Young children (0 - 5) Elementary-aged children (6 - 12) Adolescents (13 - 17) Adults (18+) Functional Level* Select All Learners who require significant supports Learners who require minimal supports Will this presentation include discussion of any commercial products or services?If the focus will be a specific publication or resource, this will be included in the workshop's description. Yes Please explain:Presenter(s) agrees to refrain from making potentially disparaging remarks while presenting.* Yes PRESENTATION SUMMARY:At least 500 words, including empirical evidence for any treatments discussed. (This is what the committee will review in detail to determine approval.)75 MINUTE TIME ORDERED AGENDA:Please do not spend time on simple background material such as definitions of autism, ABA, reinforcement, etc. This audience does not require that. Please use the following format: 15 minutes: Review of scientific literature on activity schedules 10 minutes: Practical uses of activity schedules (includes video)LEARNING OBJECTIVES:3 specific, clear, and concise objectives Sample learning objective: Participants will list five skills to teach peer tutors.BRIEF DESCRIPTION:Approximately 200-300 words for the brochure (Consider how to most clearly express what participants can expect to entice them to attend. Specific content and activity description is helpful.)Would you like your workshop to be considered for any of the following credits:Note to behavior analysts: Offering your presentation for consideration as a BACB Type 2 Continuing Education event will help to attract an audience for your presentation, ensure that BCBAs keep up-to-date with developments in ABA, and maintain the integrity and vitality of this profession. To be considered, one of the presenters must be a BCBA, and the content must extend beyond the BACB Task List. Any questions, please contact Elizabeth Neumann, M.A., BCaBA at eneumann@autismnj.org or 609.588.8200, ext. 10045 before submitting. APA Social Work BACB Social Work and APASocial Work License NumberNational Association of Social Workers member ID #Supporting Bibliography*If you think your workshop may qualify for social work or APA credits, list 3-4 current references as evidence of supporting research. Bibliography must be in APA format and at least half of the references must be published within the last 5 years. ( For APA Guide, see References here) BACBDoes this presentation cover behavior analytic theory, methods and/or practice?YesNoI attest that I have completed formal training, independent study, or supervised experiential training in the presentation's subject matter.YesNoDoes this presentation advance the knowledge of BACB certificants beyond the BACB Task List?YesNoBecause these events are to provide continuing education and professional development for certified individuals, the content and level of instruction MUST go beyond what is required to become certified. This presentation advances the knowledge of BACB certificants beyond the BACB Task List.All Presenters agree to comply with the BACB Guidelines for Responsible Conduct® during the eventClick here to view the BACB Guidelines for Responsible Conduct®YesNoI attest that I or my co-presenter meet the following BACB CE presenter requirements:YesNoOne presenter is a BCBA in good standing; holds a doctorate and meets either the coursework or college teaching option for fulfilling BCBA eligibility requirements; or has completed all requirements for a doctorate except the dissertation, meets the coursework option for BCBA eligibility, and has completed graduate coursework or published research in the subject matter.BACB certificant #
