PLEASE REMEMBER TO SAVE YOUR DATA PERIODICALLY TO AVOID DATA LOSS DUE TO TIMING OUT
EXISTING/RETURNING USERS
Returning Users  
1) If you have submitted an RFP in previous years and would like to load that data as a starting point, click here.
2) If you are returning to continue an RFP you started, enter your username and password below to retrieve it.
       Username: Password: Load Data
PRESENTERS
Names will appear in print exactly as provided below. Please make certain the spelling is correct and all relevant designations are included. If you are submitting a panel presentation, the first presenter entered will be responsible for coordinating the session.
USERNAME / PASSWORD
You have the ability to partially complete this form and then come back at a later time to finish it (up to 30 working days later). Please enter a username and password below that you can use to reload your information. Any information you have entered when you click the "Save My Data" button at the bottom of this form will be saved. Reminder - Your information is only saved when you click "Save My Data". Once your finished form is submitted, you will not be able to update your information. NOTE: If you are making more than 1 submission, you must use a unique username/password combination for each submission.
Username:
Password:
SPEAKER #1 BIOGRAPHICAL DATA and DECLARATION FORM
Instructions:  All fields must be completed before this form can be submitted online. After completion, a copy of your RFP will be emailed to you. A resume or curriculum vitae must be submitted for each speaker before completing this application process. Please note that the first speaker listed will be the primary contact with The Eden Alternative for your session.
First Name:
Last Name:
Credentials:
Address Location:
Office      Home
Address:
City:
State/Province (US/Canada):
State/Province (Non-US/Canada):
Zip:
Country:

Other:
Organization/Affiliation:
Title:
Country Code (If International)
Phone Number: Extension:
Cell Number:
Email Address:
Additional Email Address:

Education (include basic preparation through highest degree held): If not applicable, please enter NA.
Institution #1:
(Name, City and State)		 Degree:
Major Area of Study: Year Awarded:
Institution #2:
(Name, City and State)		 Degree:
Major Area of Study: Year Awarded:
Institution #3:
(Name, City and State)		 Degree:
Major Area of Study: Year Awarded:
Use the fields below to briefly describe your professional experience and areas of expertise (including publications) that contribute to your particular involvement with this continuing education activity.

Current Responsibilities (100 words or less)


Words remaining:

What makes you qualified to speak on this topic? (Please add in any certifications you have.) (100 words or less)


Words remaining:

Resume Upload

You are required to sign the vested interest form which will appear once you submit your information for review. Your submission will not be considered complete and eligible for review until an electronic signature is received.

Check here if you have additional speakers in your session. Please provide their information below.

SPEAKER #2 BIOGRAPHICAL DATA and DECLARATION FORM
Instructions:  All fields must be completed before this form can be submitted online. After completion, a copy of your RFP will be emailed to you. A resume or curriculum vitae must be submitted for each speaker before completing this application process. Please note that the first speaker listed will be the primary contact with The Eden Alternative for your session.
First Name:
Last Name:
Credentials:
Address Location:
Office      Home
Address:
City:
State/Province (US/Canada):
State/Province (Non-US/Canada):
Zip:
Country:

Other:
Organization/Affiliation:
Title:
Country Code (If International)
Phone Number: Extension:
Cell Number:
Email Address:
Additional Email Address:

Education (include basic preparation through highest degree held): If not applicable, please enter NA.
Institution #1:
(Name, City and State)		 Degree:
Major Area of Study: Year Awarded:
Institution #2:
(Name, City and State)		 Degree:
Major Area of Study: Year Awarded:
Institution #3:
(Name, City and State)		 Degree:
Major Area of Study: Year Awarded:
Use the fields below to briefly describe your professional experience and areas of expertise (including publications) that contribute to your particular involvement with this continuing education activity.

Current Responsibilities (100 words or less)


Words remaining:

What makes you qualified to speak on this topic? (Please add in any certifications you have.) (100 words or less)


Words remaining:

Resume Upload

You are required to sign the vested interest form which will appear once you submit your information for review. Your submission will not be considered complete and eligible for review until an electronic signature is received.
SPEAKER #3 BIOGRAPHICAL DATA and DECLARATION FORM
Instructions:  All fields must be completed before this form can be submitted online. After completion, a copy of your RFP will be emailed to you. A resume or curriculum vitae must be submitted for each speaker before completing this application process. Please note that the first speaker listed will be the primary contact with The Eden Alternative for your session.
First Name:
Last Name:
Credentials:
Address Location:
Office      Home
Address:
City:
State/Province (US/Canada):
State/Province (Non-US/Canada):
Zip:
Country:

Other:
Organization/Affiliation:
Title:
Country Code (If International)
Phone Number: Extension:
Cell Number:
Email Address:
Additional Email Address:

Education (include basic preparation through highest degree held): If not applicable, please enter NA.
Institution #1:
(Name, City and State)		 Degree:
Major Area of Study: Year Awarded:
Institution #2:
(Name, City and State)		 Degree:
Major Area of Study: Year Awarded:
Institution #3:
(Name, City and State)		 Degree:
Major Area of Study: Year Awarded:
Use the fields below to briefly describe your professional experience and areas of expertise (including publications) that contribute to your particular involvement with this continuing education activity.

Current Responsibilities (100 words or less)


Words remaining:

What makes you qualified to speak on this topic? (Please add in any certifications you have.) (100 words or less)


Words remaining:

Resume Upload

You are required to sign the vested interest form which will appear once you submit your information for review. Your submission will not be considered complete and eligible for review until an electronic signature is received.
SESSION INFORMATION
I am applying to speak (choose one):

Session Title: (10 words or less)


Words remaining:

Session Description: 
This detailed overview (100 words or less) of your session will be utilized to evaluate the overall significance, applicability and quality of your session content. It will also be used to describe your presentation on the website and in the conference program.


Words remaining:

Would you say your topic best fits under the heading of:

Leadership and Workforce Development
Critical Mindshifts (thinking differently about aging and aging services, redesigning systems and processes)
Community Building (bringing people together in new and innovative ways to create community)
Other Enter here:

How does this presentation speak to overcoming challenges (move mountains)?

How does this presentation speak to innovation, collaboration and getting results?

What is the current state or reason for this session?
Why is this topic important? Why is this topic important to the audience right now? What information, resource or skill gap will it fulfill for the audience?

Please provide evidence-based reference(s) used in the development of this session.

Please include the following descriptions of each section of your submission:

Objectives - List objective in measurable learner outcomes.  Objective must be consistent with the purpose of the activity.  Some examples:  The learner will be able to:  Apply, Create, Compare, Define, Discuss, Evaluate, List, Name, Plan.  Avoid the use of non-measurable verbs such as "learn" or "understand" in formulating your objectives. There must be 3 objectives per presentation.

Content (Topic) - List each topic area and a description or outline of the content to be presented.  The content must be directly related to the corresponding objectives.  These should be more than just a re-statement of the objectives.

How to word the learning objectives: https://www.bu.edu/cme/forms/RSS_forms/tips_for_writing_objectives.pdf
Learning Objectives Content Time Speaker Interactive Presentation Strategies

Audience (Please check all that apply)
Formal Leaders, Decision-Makers Employee Care Partners
Elders, Families, Volunteer Care Partners Senior Housing
Skilled Nursing CCRC/Life Plan Communities
Assisted Living Home & Community-Based Services
Small Residential Care Settings and/or Host Homes Other
      (10 words maximum)

Audio/Visual Equipment
Every break-out session will have: LCD projector, screen and one microphone. Each presenter will bring their own laptop computer. Please indicate below if you need additional equipment:

Sound (audio) for videos Flip chart (bring your own markers)
A second microphone Other:

Other comments: Is there anything else you would like to share about yourself or your presentation?

Optional: Send us a brief, no more than 2 minute, video about your proposal, why the topic is important to you, or just talk a little about yourself. The video will help us get to know you better. If you approve, we would like to use the video to help attendees get to know you better, so they can attend your session.

Do you already have a recorded presentation on YouTube that we may view? 

        If so, add the URL here:  

If not, and you plan to upload your own video:

        Click here for best practices for creating your video clip.

        Upload your video clip here.

Please consider saving a copy of your data in a Word document prior to submitting. This will prevent any potential loss due to a timing out error.

Click here to save your data for later editing and NOT submit for review.

Click here to submit your RFP for review.
(no updating after this point)