IMHCA Continuing Education Workshop Proposal
Please address the following in no more than two pages:

1. Workshop Title.

2. Educational Objectives (Knowledge and skills gained by participants, Participants will?).

3. Outline of Workshop, including content areas, information to be covered in each area, and presentation methods.

4. Workshop Description (to be included in advertisements, 50 word maximum).
Workshop Format Information (Check one):

ALL DAY (6 hrs)______

TWO DAY (12 hrs)______

HALF DAY (4 hrs)______

OTHER ______
Media Needs (Check all that apply):

Overhead Projector______

Chalk Board______

Flip Chart______

VCR______
Room Set-Up (Check all that apply):

Lecture Format______

Tables (People sitting in groups)______

Desks (People sitting individually)______

Moveable Chairs______

Room needed for large or small group activities_____

NBCC Categories:

Please check all curriculum categories which this workshop addresses (For NBCC and licensure CEU credit)

Counseling Therapy______

Human Growth and Development______

Social and Cultural Foundations______

Helping Relationships______

Groups______

Lifestyle and Career Development______

Appraisal______

Research and Program Evaluation______

Professional Orientation (e.g. ethics, professional organization, licensing, public policy procedures, and advocacy)______

Mental Health Counseling (e.g. theory, roles, applications, management, and community interventions)______

Knowledge and Skills for the Practice of Mental Health Counseling______
Presenter Information Form
Presenter Information:

1) Name:

Mailing Address:

Phone (home and work):

Fax:

Email:
2) Please include name and contact information for two references who have knowledge of your presentation skills

3) Please include resume or vita and brief (50 word maximum) bio to be included in workshop advertisements.

Academic Record:

Licensure/ Certifications:

Professional Experience

Consultation/ Training/ Program Evaluation/ Grant Reviews:

Academic Appointments/ Teaching Experience:

Research/ Teaching Assistantships:

Publications/ Papers/ Rep

Presentations: