Wisconsin Speech-Language Pathology and Audiology Professional Association

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WSHA-P
1360 Regent Street, #154
Madison, WI 53715
(800) 545-0640
FAX (888) 729-3489
wsha@wisha.org

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CALL FOR PAPERS

2010 Annual Convention
February 25-27
Oshkosh Convention Center
Oshkosh, WI

Poster Presentation only proposal deadline: November 25, 2009

Please note: Proposal submission must be complete and cannot be considered without electronic submission of all requested information.

Please Note: If approved, all information will be published as submitted. Please enter all information carefully.

*WARNING! DO NOT use your Return(Enter) key to advance to the next field while filling out this form. It will result in an incomplete form being submitted and therefore will be incorrect.

Primary Contact Information
(to receive all correspondence and be responsible for distributing all information to the authors)
First Name:
Last Name:
E-mail:
Phone:


PRESENTATION INFORMATION

Title of Proposal

Abstract of Presentation
Please provide an abstract of 150 words or less.

Content Area
Select One Audiology Pediatrics - Birth-To-Six Pediatrics - School Age Adult - Dysphagia Adult - Geriatrics Adult - Neurogenics Adult Other ------- Explain Professional Issues

Format
	1-hour session
	2-hour session
	3-hour session
	4-hour session
	Roundtable (Thursday only)
	Poster session (Saturday only)
	Exhibitor Round Robin

Instructional Level
	Introductory (assumes little or no familiarity with the subject)
	Intermediate (assumes general familiarity with the literature and professional practice within the area covered)
	Advanced (assumes thorough familiarity with current literature and professional practice within the area covered)

Day(s) available to present
	Thursday, February 25
	Friday, February 26
	Saturday, February 27

Outcomes and Assessment
Please provide 2-3 Learner Outcomes and Assessment of Learner Outcomes. To meet ASHA and AAA CEU requirements, Outcomes must demonstrate increased knowledge and/or skill in communication science, disorders and/or clinical practice. Please see the pdf file *Learning Outcomes and Assessment for instruction* for specific information about outcome language and samples of appropriate form. Only presentations that meet CEU outcome Guidelines will be accepted for the WSHA-P Convention. Learner Outcomes:
1
2
3
For Audiology Sessions - American Board of Audiology (ABA) Tier 1 Continuing Education Hours
	I am willing to tailor my presentation to meet the guidelines to offer the American Board of Audiology (ABA) Tier 1 Continuing Education Hours to attendees
Audiovisual Equipment Needs must be indicated on the form below. Additional AV requests on-site will not be arranged or paid for by WSHA-P. Only those AV items listed on the form will be provided by WSHA-P . Any additional items required will be the responsibility of the presenter to arrange with the hotel and make payment for. WSHA-P will not provide laptops for any presentations or AV equipment for poster sessions. All AV requests are subject to approval by the Convention Committee. Approval of AV requests will be provided in the Presenter Confirmation Notification. Request for LCD Projectors must complete the following: LCD Projectors are provided for still presentations. If your presentation will contain audio and/or video, you must request this on the Call for Papers. My presentation will contain audio My presentation will contain video.

AUTHOR INFORMATION

WSHA-P understands that many proposals represent the work of several individuals. In a few cases, all of the authors of the proposal cannot attend the convention. Please check if the individual listed will not be able to attend the convention.

By each authors name, please list the order they are to be listed in the Convention program.

Primary Author

First Name :

Last Name:

E-mail:

Employer:

Work city / state

Credentials:

MA
Aud
MS, CCC-SLP
MS, CCC-A
MA, CCC-SLP

PhD
MS
MD
Other

Preferred mailing address:

Home Work

Address:

City:

State:

Zip Code:

Phone:

Fax:

Order of Author:

Not Attending:

Primary Author Biographical Sketch

Please provide a short biography (maximum 100 words). Bios are required for each presenter.

Second Author

First Name :

Last Name:

Employer:

City/State:

Credentials:

MA
Aud
MS, CCC-SLP
MS, CCC-A
MA, CCC-SLP

PhD
MS
MD
Other

Order of Author:

Not Attending:

Second Author Biographical Sketch

Please provide a brief biography (maximum 100 words). Bios are required for each presenter.

Third Author

First Name :

Last Name:

Employer:

City/State:

Credentials:

MA
Aud
MS, CCC-SLP
MS, CCC-A
MA, CCC-SLP

PhD
MS
MD
Other

Order of Author:

Not Attending:

Third Author Biographical Sketch

Please provide a brief biography (maximum 100 words). Bios are required for each presenter.

If there are additional authors, please provide their name and employment information, order of author and if they will not be attending the convention.

Additional Author(s) Biographical Sketch

Please provide a brief biography (maximum 100 words) for any additional author. Bios are required for each presenter.

Presenters must disclose to participants (prior to the presentation) any proprietary interest in any product, instrument, device, service, or materials discussed in a presentation, as well as the source of compensation related to the presentation.

Primary contact will be notified regarding acceptance by October 1, 2009.

WSHA-P will place presenter's handouts on the WSHA-P website prior to the convention. The deadline for submission of handouts is January 25, 2010. Handouts must be received via electronic mail to the WSHA-P Office, wsha@wisha.org (hard copies and faxes can not be accepted.) Presenters who do not provide handouts to WSHA-P prior to this date will be responsible for providing handouts to the attendees.

Please print out this page and retain for your records, prior to submitting this form.

1360 Regent Street, #154, Madison, WI 53715 | FAX (888) 729-3489 | (800) 545-0640 | wsha@wisha.org