Nashville Airport Marriott
600 Marriott Drive
Nashville, TN 37214

Wednesday, October 30, 2019 – Saturday, November 2, 2019 [pre-convention workshop only on Wednesday]

You must complete this form in ONE SETTING. Please review the blank program proposal form on www.tpaonline.org and ensure that you have all necessary information.

If you are filling out this form and others will be presenting the program with you, have them read this form as well. You, the person filling out this form, are responsible for the terms and conditions of this proposal at presentation time.

If you have any questions about this form, particularly the AV section, please contact the Convention Operations Chair at drerinpatel@gmail.com. We have expanded the proposal form, based upon our experience with reviewing proposals, needing to seek additional information and changes in APA approval criteria for programs.

Please note that all submissions should be completely filled out and all necessary vitae submitted. Please complete all sections according to instructions. For instance, it is very important that Section C be completed as indicated. The review committee will not consider drafts, and will not provide feedback. Also, please write the abstract and goals as they will appear in the brochure. For instance, please avoid using the word “proposal” and instead use terms such as “workshop” or “this presentation will”. Also, please write the proposal in the “third” person” as this is the way the abstract will appear in the program) (i.e. “this presentation” rather than “I plan to present.”).

Email address *
A-1. Title of Presentation *
Your answer
A-2. Name of Primary Presenter *
Your answer
A-3. Professional Credentials (please email an electronic copy of your vitae to tpacontinuinged@comcast.net)
A-3i. Relevant Professional Degree(s) *
Your answer
A-3ii. Current Professional Position/Title *
Your answer
A-3iii. Current professional affiliation (e.g. private practice, University of _____, etc.) *
Your answer
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