Request for Proposals- The Root Cause Coalition's 2nd Annual Summit on the Social Determinants of Health
The Root Cause Coalition’s 2nd Annual Summit is scheduled for October 9-10, 2017 in Louisville, Kentucky. For the Summit, we are interested in receiving proposals that address the “how” in tackling a broad range of social determinants of health. Past participants have expressed a keen interest and desire to learn more about directly addressing social determinants, successful initiatives, how challenges have been identified and overcome, best practices, necessary partnerships and more. Please keep this strategy in mind as you complete the questions below. We appreciate you taking the time to complete the application, due March 8, 2017. Notification of proposal acceptance will be provided on or before May 1, 2017.
Sign in to Google to save your progress. Learn more
Presenter Information
Please note: This will be our main point of contact for the proposal
Name *
Title and Organization *
Address *
Phone *
Email Address *
Brief Bio *
Additional Presenter Information (if applicable)
Name
Title and Organization
Address
Phone
 Email
Additional Presenter Information (if applicable)
Name
Title and Organization
Address
Phone
Email
Presentation Information
Will your presentation require a moderator? If so, do you have a suggestion? *
Proposed Session Title *
My session could be: *
Required
Please indicate the social determinant(s) your session will address: *
Required
Session Summary: Succinctly describe the presentation. Please use complete sentences, as this description may be used in the final Summit program (75 word limit): *
Session objectives: Please list 3-5 objectives summarizing what attendees can expect to gain. *
Policy relevance: Please explain whether your project has policy implications. If so, are they at the local, state or national level?  If there are no policy implications, please write N/A. *
Session Uniqueness: Please explain what is unique or innovative about your approach to the health determinant(s) you are addressing.  Include any relevant outcomes/data. *
I am willing to join a panel discussion with other experts on this health determinants. *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms