Abstract Application Preview

Want to preview the application without logging in? The following information will be collected as part of the 2016 Preparedness Summit Abstract Submission Site:
*Indicates required field

Presenter Information: Please identify the presenter(s) for your session. All presenters MUST be in attendance at the session. A maximum of three (3) presenters are allowed. Additionally, each session will require a facilitator. You may choose your own independent facilitator, or request one be assigned by the conference staff.

Please provide the information below for all presenters. If there are no additional presenters, please enter your information and proceed to the next page. The Preparedness Summit will be applying for Continuing Education Units (CEUs) through the Centers for Disease Control and Prevention (CDC) for those who attend the Summit. It is a requirement by the CDC that the information in the fields below are provided and accurate to ensure each session will qualify for CEUs.If you are completing the information on behalf of someone else, and do not know the answer, please indicate with N/A. We will contact the presenter for the required information should the abstract be accepted.  

*Will you be a presenter, or are you submitting this abstract on behalf of someone else? (please select one)

  • I am a presenter (and will list my contact information below)
  • I am submitting this abstract on behalf of someone else (do not list your contact information below)

Presenter #1-3
*The Preparedness Summit may audio record my session for attendees to access after the conference.

I agree to have the session recorded:

  • Yes, I agree
  • No, I do not agree

*First Name:
*Last Name:
Degrees/Credentials (e.g. MS, PhD,etc):
*Position/Title:
*Organization Affiliation
(Note: If affiliated with a federal agency, include division and agency name only: e.g. CDC/COTPER):
*Address:
Address (line 2):
*City:
*State:
*Zip Code:
*Phone Number
(xxx)-xxx-xxxx:
*Email Address:

Education: List highest degree held first. If no post-secondary education has been completed, please enter relevant independent classes or certifications. If there is no education to be listed, please print “None” in each box.

  • *Degree (highest):
    *Year:
    *Institution, City, State:
    *Major Area of Study:
  • Degree (second highest):
    Year:
    Institution, City, State:
    Major Area of Study:
  • Degree (third highest):
    Year:
    Institution, City, State:
    Major Area of Study:

*Qualifications relevant to this educational activity:
What qualifies you to present, contribute content, or be a planner for this educational activity. Briefly describe only the relevant expertise and publications. (250 max)

Disclosure Information (CDC COI Form):

*Is there an actual, potential or perceived conflict of interest for yourself or spouse/partner?   

I have relevant financial relationships with commercial interests.

  • Yes – complete disclosure information in next question.
  • No – skip disclosure information in next question.

If yes, complete the table below for all actual, potential, or perceived conflicts of interest. Check all that apply.

Abstract Example

 

 

 

 

 

*Will the presentation or the content contributed by presenter 1 include any discussion of unlabeled use of commercial products or products for investigational use?

  • Yes – please explain
  • No

Abstract Information

Please provide the following information regarding your abstract and note the word/character limits of each section.

NOTE: Please do not use the & symbol in your answers, as this will cause the system to give you an error message and fail to save your responses.

*Session Title: (25 words or less)

For more detailed instructions on abstract submission and reviewer expectations please visit http://www.preparednesssummit.org/abstract/.

*Conference Tracks:

The conference tracks are designed to support learning objectives.  Overall, under which conference track does the proposed session best fit. Please select only one. View Conference Tracks’ Descriptions.

*Session Submission Type (first choice):

  • 3 Hour Workshop/Training
  • Learning Session (90-minutes)
  • Demonstration (90 minute DEMO)
  • Poster Session

Session Submission Type (second choice):

  • 3 Hour Workshop/Training
  • Learning Session (90-minutes)
  • Demonstration (90 minute DEMO)
  • Poster Session

*Session Description for Review (limit 500 words/4,000 characters, including spaces):

*Session Description for Publication (web, conference program) (limit 50 words/350 characters, including spaces):

*Learning Objective 1 – Please select the conference learning objective that best connects to your session.

At the conclusion of this session, attendees will be able to:

1. Identify current priority areas in public health and healthcare preparedness at the local, state, tribal, and national levels;

2. Identify current priority areas in public health preparedness resilience and recovery, at the local, state, tribal, and national levels;

3. Describe emerging practices and theories that can be applied to improve community preparedness and community resilience at the local, state, tribal, and national levels;

4. Assess key resources and tools that will enhance or sustain professional work or volunteer role in planning for, responding to, and recovering from disasters and other public health emergencies;

5. Identify opportunities to engage with national stakeholders on Federal guidance and policy issues that will impact state and local preparedness.

*Learning Objective 2 – At the conclusion of this session, attendees will be able to: (limit 40 words)

*Learning Objective 3 – At the conclusion of this session, attendees will be able to: (limit 40 words)

Please indicate the level of the audience this session is designed to reach. Professionals who have been in their current position:

  • 0-2 years – Introductory Awareness
  • 2-5 years – Intermediate Knowledge Transfer
  • More than 5 years – Advance Skill Building
  • All of the above

*Has this abstract, or any portion of it, been submitted and approved for any other conference?

  • Yes
  • No

If ‘Yes’, what conference and when was the date of presentation?

Workshop Sessions

Please answer the questions below, only if you have selected a submission type of “3 Hour Workshop/Training”

What is the minimum number of attendees needed to successfully conduct this workshop?

What is the maximum number of attendees your workshop/training can accommodate?

Does your training have any unique needs? (i.e. AV, internet access, or additional space requirements) Some requests will result in additional expenses and will need to be considered during the review.

I understand that all workshops and trainings will require that I administer evaluations to assess attendee learning.

  • Yes
  • No

Moderator/Facilitator Information

Moderator Information: Please indicate if you have selected a moderator for your session.
The role of the moderator is to ensure that the session begins and ends on time as well as facilitates the question and answer portion of the session.

*Do you have a moderator/facilitator planned for this session?

  • Yes, this person will serve as moderator (please list contact information below)
  • No, Preparedness Summit Planning Committee will assign session moderator

Moderator First Name:
Moderator Last Name:
Degrees/Credentials (e.g. MS, PhD, etc):
Organization:
Position/Title:
Address:
Address (Line 2):
City:
State:
Zip Code:
Phone Number:
Email Address: