TideWater Speaker Submission Form

Name(Required)

First Last Credentials

Email(Required)

Phone(Required)

Title of Your Activity(Required)

List 3-5 objectives for your presentation(Required)

Use words such as evaluate, identify, and describe when writing your learning objectives

Please Provide a brief biography about yourself so we can introduce you prior to your presentation:(Required)

What is the problem/opportunity/issue that has created the need for this educational activity?

This is known as the Professional Practice Gap. What is the problem/opportunity/issue that has created the need for educational activity? Is it a change in standard of care, problem in practice, or opportunity for improvement (knowledge, skills or practice)? Please provide a 1-2 sentence response below identifying the professional practice gap based on your presentation topic.

Provide a brief summary of the evidence that supports this problem/opportunity/issue exists on the topic you are presenting.

Focus on the evidence that demonstrates the problem exists and NOT on the content of the activity. Why is this happening and how do you know it could be done better?

Content of Activity: Please provide a short paragraph description (2-4 sentences) or outline summarizing the content to be provided.

Please provide current and evidence-based resources that will support the development of the content of this educational activity.

Need 3 resources for each one hour of activity. List the authors, titles, and dates of publication. Resources should be from the past 5-7 years. If a content expert will be a resource, please also ensure there is another evidence-based resource to support the content. It is not required to provide an exhaustive list of content resources.

TideWater Speaker Submission Form

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