Educational Course Proposal

APTA Member

If you are an APTA member, please enter your Member number and last name.

Educational Course Proposal

Proposed Course Title

Please select the proposed course format:

Online- 1 hour course
Online- 1 course, several hours long
Webinar
Other

Other course format

Which Academy of Neurologic Physical Therapy Strategic Plan Objectives does this educational activity meet?

See a copy of the Strategic Plan under "About Us" on the website.

Who is the target audience for this educational offering?

How does the proposed course fill an education gap?

How frequently will the course content require updating?

Have you previously developed and/or developed a course on this topic? Are you currently offering this course?

Collaborating entities

Have you received the support of collaborating/supporting entities (e.g. foundations, agencies, organizations) when presenting this course or others in the past? If yes, describe any support by a collaborating entity.

Would you be willing to secure their support if the Academy determined it helpful and not in conflict with other interests or initiatives?

About you ...

I would be a developer of the proposed course, but do NOT wish to present it. I am comfortable with the Academy identifying qualified presenters on my behalf
I would be a presenter of the course proposed above, but am not a developer of the material. I am comfortable being paired with a development team on this topic and/or other co-presenters identified by the Academy
I would be both a developer and a presenter of the proposed course

Disclosure of conflict of interest: The most common potential conflict of interest is the endorsement or promotion of a product in presentations. If a manufacturer has provided you with equipment without a fee (or a substantially reduced fee) and you discuss the equipment in your presentation, and/or the manufacturer has provided financial support to you, this information should be disclosed to the audience. If there is a potential conflict of interest related to your presentation, we ask that you disclose it below.

I am unaware of any potential conflict of interest related to the proposed course.
I have a relationship with an entity that could cause a potential conflict of interest.

If so, please explain: