Pioneer Network
Returning Users  
1) If you have submitted a proposal in previous years and would like to load that data as a starting point for a 2019 proposal, enter your first and last name and click "Find RFP".
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2) If you are returning to update a proposal you have already started for 2019, please retrieve your information by providing your username and password below.
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New Submissions  
Each proposal submitted must have a unique username and password.
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2019 Conference RFP:
“Pioneering a New Culture of Aging”

  • Please be sure you save your work periodically while working on this form, particularly if you will be away from your computer for an extended period of time. 
  • All fields must be completed before this form can be considered for review.   
  • After completion, you will be able to print out a copy for your records. 
  • Please note that if you are completing more than one submission, you will need to create a unique username and password for each submission. 
  • For questions pertaining to the form or the process, please contact Misty Frank at misty@optplanning.com or call 240-481-3758. For questions pertaining to session content, please contact Joan Devine, Director of Education at  joan.devine@pioneernetwork.net or 636-578-4164. 
  • Be sure you review "What You Need to Know Before Submitting Your Proposal" on the conference page of the Pioneer Network website before writing your proposal. https://www.pioneernetwork.net/conference/
  • You will have the ability to complete this form in its entirety or save in steps and complete at a later date. Any information submitted by clicking "SAVE MY DATA" will be saved to the form. NOTE: Deadline for submission is Friday, December 7. 

Please indicate the length of the session your submission is for.

Lead Guide/Presenter Information

When considering the number of guides/presenters who will be involved in your presentation, please consider that you want to have ample time to interact with your audience members during the session.  Having more than 1 guide/presenter is always encouraged, and strongly recommended for 2-1/2 or 5-hour sessions. 

A resume or curriculum vitae must be submitted for each guide/presenter for the submission to be considered complete.
First Name:
Last Name:
Title:
Organization / Affiliation:
Address: Office
Address 2:
City:
State:
Zip:
Country (if other than USA)
Phone:
Cell Number:
Email Address:
Guide/Presenter 1 CV/Resume Upload:
Guide/Presenter 1 Photo/Head Shot Upload:

If accepted as a guide/presenter, this picture will be used on the registration site, on-line program and may be used in Social Media sites managed by Pioneer Network.  A professional photo is not necessary.  A high-quality photo from a cell phone can be submitted.
Additional Email Address for Confirmation:
Presented Before: No
Were you referred by someone to submit a proposal? No

If yes, by Whom:

Education – Please include basic preparation through your highest degree held.  If not applicable, please indicate NA in the first row across. We want to hear from all.

School #1:
(Name, City and State)
Degree:
Major Area of Study: Year Awarded:

School #2:
(Name, City and State)
Degree:
Major Area of Study: Year Awarded:

School #3:
(Name, City and State)
Degree:
Major Area of Study: Year Awarded:

Pertinent Qualifying Experience in content area (please limit to 100 words or less)


Words remaining:

Current Responsibilities in content area (please limit to 100 words or less)


Words remaining:

Brief paragraph that informs the reader of who you are including your background/experience related to the culture change movement. (please limit to 200 words or less) View bio example


Words remaining:

There will be a second guide/presenter (this section must be completed for the second guide/presenter).

First Name:
Last Name:
Title:
Organization / Affiliation:
Address: Office
Address 2:
City:
State:
Zip:
Country (if other than USA)
Phone:
Cell Number:
Email Address:
Additional Email Address for Confirmation:
Presented Before: No

Education – Please include basic preparation through your highest degree held.  If not applicable, please indicate NA in the first row across.  We want to hear from all.

School #1:
(Name, City and State)
Degree:
Major Area of Study: Year Awarded:

School #2:
(Name, City and State)
Degree:
Major Area of Study: Year Awarded:

School #3:
(Name, City and State)
Degree:
Major Area of Study: Year Awarded:

 

Pertinent Qualifying Experience in content area (please limit to 100 words or less)


Words remaining:

Current Responsibilities in content area (please limit to 100 words or less)


Words remaining:

Brief paragraph that informs the reader of who you are including your background/experience related to the culture change movement. (please limit to 200 words or less) View bio example


Words remaining:

Guide/Presenter 2 CV/Resume Upload

Guide/Presenter 2 Photo/Head Shot Upload

There will be more than two guides/presenters and/or there will be panelists participating in the session.

First Name Last Name Title Organization Email Address

Pertinent Qualifying Experience in content area (please limit to 100 words or less)


Words remaining:

Current Responsibilities in content area (please limit to 100 words or less)


Words remaining:

CV/Resume Upload


First Name Last Name Title Organization Email Address

Pertinent Qualifying Experience in content area (please limit to 100 words or less)


Words remaining:

Current Responsibilities in content area (please limit to 100 words or less)


Words remaining:

CV/Resume Upload


First Name Last Name Title Organization Email Address

Pertinent Qualifying Experience in content area (please limit to 100 words or less)


Words remaining:

Current Responsibilities in content area (please limit to 100 words or less)


Words remaining:

CV/Resume Upload


First Name Last Name Title Organization Email Address

Pertinent Qualifying Experience in content area (please limit to 100 words or less)


Words remaining:

Current Responsibilities in content area (please limit to 100 words or less)


Words remaining:

CV/Resume Upload


First Name Last Name Title Organization Email Address

Pertinent Qualifying Experience in content area (please limit to 100 words or less)


Words remaining:

Current Responsibilities in content area (please limit to 100 words or less)


Words remaining:

CV/Resume Upload


Session Title (Please be brief and limit to no more than 10 words)


Words remaining:

Session Summary (Please provide a short summary of your session and intended outcome. This is limited to no more than 100 words. This is what attendees will read to make their decision on which session to attend.)


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Session Resource Please provide a description of content you will include in a resource that supports the content of your session.  It will be provided to attendees as a Downloadable PDF document.  It should contain information that has practical application for the attendee which they can bring back to their team providing a practical resource to use to take action on what they learned in your session.  Examples of session resources include: tip sheet, fact sheet, take home exercise, list of how to’s, a highlight from your session, learning circle questions related to your topic, list of resources for further study (ie.g.. website, books, webinars).  The resource IS NOT an outline of your session or your powerpoint slides.


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Relationship to Conference Theme Our conference theme is Pioneering a New Culture of Aging, and this year’s focus will be Making it Happen.  As we at Pioneer Network look to the future and contemplate how to “make it happen”, we look to some underlying beliefs that are ingrained in our culture and in each of us that impede out work.   One of these is ageism.  It is so ingrained in our society and in each of us, that it influences what services we provide and how we provide them.   

And so, we ask each presenter to consider how ageism relates to their work and the topic they are presenting on, and to provide a brief statement as to how this can be integrated into their presentation. 

Worth noting is that 65% of our conference attendees are "first timers".  We need to provide appropriate sessions for their phase of the journey.  Please check the appropriate category for your session.

Getting Started Sustaining Advanced All

Topic area(s) most aligned with your session (choose up to 3)

Advocacy
Ageism / Stigma
Building Community
Clinical Practice
Dementia / Dementia Care
Dining
Diversity
Intergenerational Programming
Leadership
Life Enrichment / Wellness
Non-Traditional Settings
Palliative Care / End of Life Care
Quality Assurance / Performance Improvement
Regulatory Compliance
Research
Resident Voice / Advocacy
Technology / Innovation
Workforce
Other, please specify
      
           Words remaining:

Target Settings – Select all of the following settings that your session will address:

Adult Day Services
Aging Network Agencies (e.g. Area Agencies on Aging and/or their providers)
Assisted Living
Home Care
Hospice
Hospitals
Memory Care
Nursing Homes
PACE Programs
Rehabilitation/Post-Acute Services
Retirement Communities
Senior Centers
Senior Housing
Wellness Centers
Others, please explain in less than 10 words
           Words remaining:

Primary Audience – Select all that apply

Clinical Staff
Dining Staff
Direct Care Staff
Middle Managers
Resident / Elders
Senior Leadership
Other, please specify
      
           Words remaining:

Area of desired/achievable outcome your session will address:

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

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

Objectives - list measurable objectives. Start each with such words as: Apply, Create, Compare, Define, Discuss, Evaluate, List, Name, Plan. Avoid the use of words that are not measurable such as Learn or Understand.

Content (Topic) - List each topic area and a description of content to be addressed. It must be directly related to the corresponding objective. This should be more than a restatement of the objective.

Time Frame: the time frames listed must add up to the total time allotted for the session Guide/Presenter (person(s) completing this portion)

Guide/Presenter (person(s) completing this portion)

Teaching Methods - List methods, strategies, resources materials for each objective. Examples include lecture, panel, discussion, interactive group exercises, case study, role playing, Q&A, use of props, experiential learning.

Objectives Content (Topic) Time Frame Guide/Presenter Teaching Methods

By submitting, you agree that the information you are providing is accurate to the best of your knowledge.  Guide/Presenter acknowledges he/she is responsible for their own travel, hotel arrangements/fees and costs, and will not receive a speaker fee or honorarium.  Up to 2 guides/presenters (up to 2 per session will receive a reduced registration fee. Guide/Presenter also agrees to forward handouts for the session and session resource no later than June 28, 2019.

If my proposal is not selected for an oral presentation, I would be interested in presenting it as a Poster Session/Story Board

No

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