CALL FOR PAPERS for the ANNUAL COTA CONFERENCE

Lehigh Carbon Community College 4525 Education Park Drive

Schnecksville, PA 18078

You are invited to share your innovations, clinical experiences, and/or research by submitting a proposal to present at the Annual COTA Conference. Practitioners, educators, researchers and students are invited to share knowledge, research findings and best practices which reflect the diversity of occupational therapy. You are welcome to submit proposals for a workshop (2-3 hours), or topic lecture (90 minutes), or luncheon session (60 minutes). Presenters receive an honorarium for presenting and is based on the length of the session. Sessions that are team taught with a COTA and an OT will be given primary consideration.

Proposal Instructions

The Proposal Description should (1) describe the topic or issue addressed, (2) provide an overview of the content or findings, (3) describe importance or contribution of the session to the profession, and (4) describe session format – skill building, program description, panel discussion, etc.

Each proposal must contain the following items: 1. A completed Proposal Cover Sheet (1 copy).2. The Program Description (3 copies) of 500 words or less excluding references.3. A completed Program Abstract Sheet (3 copies) including 3-5 bulleted learning objectives of your

presentation for use in the printed conference program (125 words).4. A completed and signed Application to Become an AOTA Approved Continuing Education Program

with accompanying resume/CV.5. A brief one-paragraph biography for each presenter.

This Proposal Cover Sheet and Application to Become an AOTA Approved Continuing Education Program presenter will be emailed to you upon request. Proposals will be peer reviewed. Acceptance decisions will be based on the content, quality of the opportunity for hands-on learning identified in the written proposal and the completeness of the submission. Notification of proposal acceptance or rejections will be sent out mid-February of each year.

Proposals for the Annual COTA Conference should be post-marked or e-mailed by January 1 of each year to:

Cindy Rifenburg Lehigh Carbon Community College

4525 Education Park Drive Schnecksville, PA 18078

610-799-1548 crifenburg@lccc.edu

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Application for Approval of COTA Conference-Sponsored Continuing Competency Presentation

TITLE OF PROGRAM:

NAME OF PRESENTER(S) AND PROFESSIONAL TITLES/CREDENTIALS:

TYPE OF PROGRAM/Method: Lecture Lectures and Hands-on Lab

LENGTH: 1½ Hours 3 Hours N/A Other: LAB WITH PRESENTATION: No Yes:CONTENT AREA: Administration/management Pediatrics Wellness/HealthMental Health Physical Disabilities Gerontology Colloquium Technology Work Programs Education Research OtherANNUAL CONFERENCE AUDIO-VISUAL REQUESTS, PLEASE NOTE: LCD projector, screen podium and microphone (if needed) will be provided. Laptops and other A/V equipment will not be provided. We will do our best to accommodate other needs; please contact the COTA conference chair @ crifenburg@lccc.edu.

PRIMARY CONTACT INFORMATION (Please PRINT):

Name: Day Phone Number:

Address: Evening Phone Number:

City, State, Zip: Email: REQUIRED ATTACHMENTS: Description or abstract typed on a separate piece of paper or page and,

• Is 125 words or less INCLUDING three to five bulleted quantitative & measurable learning objectives• Includes the name of the program, but DOES NOT include the presenter(s) name(s) or other

identifying information (for review and selection process)

Completed “Application To Become An AOTA Approved Continuing Education Program” Signed forms, resume/CV, and brief bio for EACH co-presenter. PLEASE NOTE: Signature required

for each co-presenter on: Disclosure, Copyright, Release of Info, Professional Conduct statements. Previously approved AOTA approved presentation, documentation attached or provide additional

information (date, etc.):

By submitting this proposal, speakers agree that should their presentation be chosen, they are able to present on the first Saturday in June at any time requested. Reasonable accommodations will be taken into consideration with proposal submission.

INCOMPLETE PROPOSALS WILL NOT BE CONSIDERED

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Application for Approval of COTA Conference-Sponsored Continuing Competency

Presentation (Please include ancillary materials, if necessary)

Course Title:

Presenter(s):

Primary Contact Address:

City: State: Zip:

Phone: Fax: Email:

Length of course: Location:

Target Audience:

Educational Level: Introductory Class Size Maximum: Intermediate Advanced

Course prerequisites: No Yes:

A-V Needs - Screen, podium, PowerPoint projector, computer, and microphone (if needed) will be provided upon request. Laptops and other A/V equipment will not be provided. Please contact the COTA conference committee members through crifenburg@lccc.edu.

Photocopies: Presenter will be responsible for copying and delivering materials for the program.

Course Description ( attached)

Quantitative and measurable outcomes/learning objectives ( attached) (Ex: “After completion of this course, the participant will learn…”)

Brief biography for each presenter to be used for promotion/introduction ( attached)

Resume or CV must be attached for each presenter. Signed forms are required for each presenter.

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Program Title:

Location (if known): Date of Course (if known):

Indicate all applicable AOTA Categories, Topics and Subtopics as applicable. Without topics and subtopics selected, your application cannot be reviewed.

Please circle all categories applicable to your session and return this form with your application

Category 1: DOMAIN OF OT

Category 2: OCCUPATIONAL THERAPY PROCESS

Category 3: PROFESSIONAL ISSUES

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DISCLOSURE POLICY

It is the policy of the Lehigh Carbon Community College COTA Conference Committee that all presenters and speakers must disclose any financial interests or other relationships (i.e., manufacturers, vendors, grant sources, research support, consultant relationships, honoraria, etc) regarding products, services or outcomes that may be discussed in the educational presentation.

The COTA Conference does not imply that such financial or other interests or relationships would prevent the speaker from making a presentation. However, it is imperative that such financial interests or relationships be identified by the speaker so that participants of the educational program may have these facts fully disclosed prior to the presentation, and may form their own judgments about the presentation.

The commercial support standards require that presentations give a balanced view of therapeutic options, preferably using generic names. If it is necessary to use a trade name, then please use those of several companies. Further, should your presentation include discussion of any unlabeled or investigational use of a commercial product, you are required to disclose this to the participants.

In keeping with this policy, the speaker is required to sign the following disclosure statement.

FULL DISCLOSURE STATEMENT: Please sign A OR B, whichever is applicable.NOTE: Your typed signature on this document constitutes your legal signature in accordance with21 CFR Part 11: Electronic Records; Electronic Signatures Act.

Program Title:

Location (if known): Date of Course (if known):

A. I, the undersigned, declare that I do NOT have a financial interest or other relationship with manufacturers, companies, organizations or individuals that requires disclosure for this program.

Signature & Last Name Printed

Date:

B. I, the undersigned, declare that I do have a financial interest or other relationship with manufacturers, companies, organizations or individuals that requires disclosure for this program. This interest is specified below:

Signature & Last Name Printed

Date:

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COPYRIGHT, INTELLECTUAL, PROPERTY RIGHTS AND RELEASE OF INFORMATION

The COTA Conference Committee respects the copyright laws meant to protect original works.All presenters are to clearly note information from any non-original source and document the source withinaudio-visual aides and handouts.

The COTA Conference Committee recognizes that presenters may have prepared propriety educationalmaterials. However, as a provider of continuing education courses, LCCC COTA Conference expectspresenters to agree to the copying and distribution of materials that are to be shared at the Annual COTAConference and sponsored educational programs.

PLEASE PRINTNOTE: Your electronic (typed) signature on this document constitutes your legal signature in accordancewith 21 CFR Part 11: Electronic Records; Electronic Signatures Act.

Program Title:

Location (if known): Date of Course (if known):

RELEASE OF INFORMATION STATEMENT: Please sign and date below.

I agree that the COTA Conference Committee has the right to use the educational materials I presentand distribute to participants of their continuing education programs.

Further, I affirm that the material I am presenting is original or that I have written permission fromcopyright holder to use his/her materials.

Signature & Last Name Printed:

Date:

PROFESSIONAL CONDUCT STATEMENT: Please sign and date below.

I affirm that I am in good standing within the profession I am affiliated with, I demonstrate high standardsof professional conduct and code of ethics, and I do not discriminate against participants on the basis ofgender, age, socioeconomic or ethnic background, sexual orientation, or disability.

Signature & Last Name Printed:

Date:

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