Request for Proposal Form
for the 16th Annual Ending Sexual Assault & Domestic Violence Conference to be held on December 10-12, 2014

Attention: Resume or curriculum vitae for each presenter must be submitted.
(Curriculum vitae/resume and bio are required for continuing education credit application.)

Return resume and/or CV by June 6, 2014 to etamas@kasap.org,
fax to 502-226-2725, or mail to KASAP, PO Box 4028, Frankfort, KY 40604.
o Proposals will be reviewed on June 19, 2014. No late proposals will be considered.
o Presenters will be notified by June 30, 2014 as to whether the proposal was selected.
o Multiple proposals will be accepted.

It is anticipated that this conference will have approximately 500 registered participants from the following fields: power-based violence victim (child and adult) services (advocacy, treatment and education), law enforcement, nursing, disability, violence prevention, social welfare, batterer and sex offender treatment, social justice, criminal justice, legal, education, mental health, and government in the following focus areas: Human Trafficking, Disabilities, Substance Abuse, Primary Prevention/Social Change, Advanced Clinical/Mental Health, Non-Profit Administration, Children & Youth, Self Care, SART Issues, and Working with Marginalized Communities Including Male Victims.

1. Session Title
(please limit to 50 characters):
Your answer
2. Session Abstract
(limit of 50 words): This will appear as written in the conference program. It should be written to accurately describe your session and attract participants.
Your answer
3. How does the workshop relate to and/or intersect with sexual assault and/or domestic violence?
Your answer
4. Learning Objectives
Please list at least three (3) learning objectives. Identify new skills or knowledge the participant will have upon completion of the presentation. This is necessary to assure CE credit for workshop participants. Send additional pages if necessary to etamas@kasap.org.
Your answer
5. Meeting your learning objectives
To meet your learning objectives, what principles of adult learning and instructional systems do you plan to include with your presentation? Here is a website that describes the principles: http://www.nhi.fhwa.dot.gov/downloads/freebies/172/PR%20Pre-course%20Reading%20Assignment.pdf
Your answer
6. Preferred Session Date
Please select your first, second, and third choice in the following drop down menus. Please note that your first choice is not guaranteed.
Session Date, First Choice
Session Date, Second Choice
Session Date, Third Choice
7. Session Type
What type of session are you interested in?
Required
8. Categories
Please choose the appropriate categories for your workshop
Required
8a. Categories
Please choose the appropriate category for your workshop
Required
9. Skill Level
(Please indicate best audience for your presentation): Please be aware that the level may be changed by the planning committee.
Required
10. Audio/Visual Equipment
(all workshops will be provided with a laptop, projector and 1 wireless mic). Please indicate additional needs:
Required
11. Draft Presentation attached
Please provide a PowerPoint presentation or detailed outline by sending the file to etamas@kasap.org. Credentialing boards require workshop information for continued education credit. Failure to submit this information may result in declination of the proposal.
12. Handouts
PLEASE NOTE: all handouts are provided to participants in electronic form at the start of the conference. If your workshop is accepted, you will be asked to submit all handouts in electronic form by November 1, 2014. If a handout is specifically used during the workshop and you need hardcopies to distribute, please advise:
13. Name(s) of Presenters
• List the “organizer/lead presenter” first, this person will serve as a contact person for KASAP/KDVA and will be responsible for communicating with other presenters.
• Proposals must describe all presenters, including biographical sketch and must have CV/ resume submitted for all presenters. Proposals that do not include bio and CV/resume, 2 documents, for all presenters are considered incomplete and may not be considered.
• All presenters must be in attendance at the presentation.
• If more than 3 presenters, please attach additional page to proposal.
Organizer/Lead Presenter
Name
Your answer
Credentials (i.e. BA, MSW, PhD)
Your answer
Job Title
Your answer
Organization/Agency:
Your answer
Street Address
Your answer
City, State, Zip
Your answer
Phone Number
Your answer
Fax Number
Your answer
Email Address
Your answer
Brief Biolgraphical Sketch (Bio)
Please limit your bio to three (3) typewritten lines (as it should appear in conference materials and CEU applications).
Your answer
CV or Resume for Orangizer/Lead Presenter has been emailed to etamas@kasap.org
Required
I have the following needs
Presenter #2
Name
Your answer
Credentials (i.e. BA, MSW, PhD)
Your answer
Job Title
Your answer
Organization/Agency:
Your answer
Street Address
Your answer
City, State, Zip
Your answer
Phone Number
Your answer
Fax Number
Your answer
Email Address
Your answer
Brief Biolgraphical Sketch (Bio)
Please limit your bio to three (3) typewritten lines (as it should appear in conference materials and CEU applications).
Your answer
CV or Resume for Orangizer/Lead Presenter has been emailed to etamas@kasap.org
I have the following needs
Presenter #3
Name
Your answer
Credentials (i.e. BA, MSW, PhD)
Your answer
Job Title
Your answer
Organization/Agency:
Your answer
Street Address
Your answer
City, State, Zip
Your answer
Phone Number
Your answer
Fax Number
Your answer
Email Address
Your answer
Brief Biolgraphical Sketch (Bio)
Please limit your bio to three (3) typewritten lines (as it should appear in conference materials and CEU applications).
Your answer
CV or Resume for Orangizer/Lead Presenter has been emailed to etamas@kasap.org
I have the following needs
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