If you have questions regarding this form, or need assistance completing it, please call us at 323-650-5467 or email us at conference@tlpi.org
Name of person from OVC or TLPI who asked you to complete this form:
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Full Name:
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First Name
Last Name
Tribal Affiliation (if any):
Job Title:
Agency/Organization:
Address:
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email:
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example@example.com
Phone Number:
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-
Area Code
Phone Number
Presenter Biography:
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Please provide brief biographical information about yourself for the conference program. Please limit to 250 words or less.
Names of Co-Presenters (if any):
Co-Presenters Biography:
If you have listed co-presenters above, a short biography is required. Please limit to 250 words or less.
Proposed Presentation Title:
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Presentation Description:
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In 50 words or less, describe the theme and purpose of your presentation. This information will be published as received so please carefully proof-read your submission.
Please select a topic area into which you feel your Presentation falls.
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Advocacy
Child Abuse
Courts/Justice System Response
Culture/Tradition
Domestic Violence
Drug Alcohol Issues
Elder Abuse
Federal Laws Impacting Victims
Healing the Healer
Healing and Wellness
Grant Management
Juvenile Justice
Law Enforcement Response
Multi Disciplinary Response
Research/Data/Evaluation
Sex Trafficking
Sexual Assault
Tribal-State-Federal Collaboration
Victim Resources
Other
Intended Audience:
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For whom is this presentation intended?
Learning Objectives:
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Please list three learning objectives for your presentation.
Level of difficulty of your presentation:
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Beginner
Intermediate
Advanced
Have you or your co-presenter presented to a native audience before?
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Yes
No
Do you or your co-presenters have Juris Doctorate degrees?
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Yes
No
Primary Presenter Expenses:
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My agency/organization will pay all of my expenses.
I am asking for a lodging scholarship.
I am asking for an airfare or mileage scholarship.
I am asking for both lodging and travel scholarship.
Co-presenter Expenses:
If you are requesting scholarships for any co-presenters, please list each co-presenter and their scholarship requests. Please note that OVC can fund a maximum of three scholarships per workshop.
Funding Source:
Please list the agency/organization that will be funding your presentation; i.e. if you are are a federal grantee please list the name of the agency this is funding your presentation. If this does not apply to you, please write in “Not Applicable”.
Scheduling
Is there a time on Wednesday December 5 or Thursday December 6 that you cannot present your workshop?
Are you willing to repeat your Presentation ?
Yes
No
Special Needs:
Please let us know if you have any special needs so we can insure that your room is appropriate for you, or let us know anything else that you feel is important.
Submit
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