<b>Business Partner Webinar Proposal Application</b>

LeadingAge Minnesota Business Partner Webinar Proposal Application

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Business Partner Webinar Proposal Application

	Thank you for your interest in presenting a LeadingAge Minnesota webinar! To submit your proposal, complete the online application. Complete a separate application for each proposed webinar. We are always looking for webinar topics so there is no deadline for submission. Proposal applications that fail to meet all guidelines or are incomplete will not be considered for review.

1.	Topic Area of Webinar:

2.	Webinar Title: Limit to eight words

3.	What critical member need is this webinar addressing?

4.	Please indicate who will be presenting with you from outside of your organization.

	Learning Objectives: What will the webinar participant learn? As the title implies, these are learner focused and speak to what will be different for them after participating in the webinar. "By the end of this educational webinar, participants will be able to..."

5.	Learning Objective #1:

6.	Learning Objective #2:

7.	Learning Objective #3:

Proposed webinar length:

	60 minutes
	90 minutes

Level of Content to be Presented:
Check only one

	Advanced level (Participants have a thorough understanding of the topic and want to do something further with it or take it to the next level by synthesizing it, etc.)
	Intermediate level (Participants have a good knowledge of the topic. The webinar's focus would be to enhance or clarify it.)
	Beginning level (Participants have little or no prior knowledge of the area covered. The focus is to provide basic knowledge of a topic.)

10.

Audience by Provider Community Type:
Check only one

	Adult Day Services
	Assisted Living/HWS
	Care Center
	Community-Based Services
	Senior Housing (Independent)
	All Audiences

12.	Content Description: Provide a detailed overview (no more than 300 words) of the webinar (beyond the learning objectives you listed) and describe how the subject matter will be delivered via your webinar, i.e., case studies, pictorial, illustrations, etc. Please focus on what will be covered and what participants will take away, rather than who will be delivering it.

	Lead Speaker Information

13.	Name:

14.	Title:

15.	Organization:

16.	Phone:

17.	Email: Please make sure this email address is valid.

18.	Bio: Include no more than a three to five sentence bio.

19.	If you have not spoken at a LeadingAge Minnesota event before, please list a professional reference:

	Additional Speaker Information

20.	Name:

21.	Title:

22.	Organization:

23.	Phone:

24.	Email:

25.	Bio: Include no more than a three to five sentence bio.

	CONSENT: On behalf of its members, LeadingAge Minnesota staff seeks to keep webinar registration fees as reasonably priced as possible and looks to Business Partners to help support our efforts. The consent items below reflect that philosophy of operation. Please check each statement to indicate consent.

26.

		Agree
I understand that I am responsible for paying all related expenses associated with my participation in this webinar (development time, etc.).
I will inform LeadingAge Minnesota within 30 days prior to the webinar if, for any reason, the webinar will not be presented and/or will find a suitable replacement.
I understand a PowerPoint presentation is required at least one week in advance of scheduled webinar.
I understand that LeadingAge Minnesota charges a fee to webinar participants and that all monies will be retained by LeadingAge Minnesota.
I understand that LeadingAge Minnesota will record my presentation and make it available for on-demand purchase (all monies will be retained by LeadingAge Minnesota). I authorize LeadingAge Minnesota to record, reproduce, and publish my presentation in whole or in part with proper credit.
I understand that promoting a company, service, or product during the session is prohibited. It both detracts from a positive learning experience for the attendees and risks putting me and my company in a less than positive light.
I agree to review my PowerPoint slides to make sure that any pictures, graphs, cartoons, etc., used are copyright free.

Steps for Submitting a Proposal

1. Verify all the information submitted in the application is correct.

2. Save and/or print a text file (.txt) copy of your application for your records/future reference.

3. Click on the "Done" tab. (After you click "Done," wait for the thank you message to appear. Do not click the "Done" more than one time. Clicking your browser's "Stop" button may or may not stop your submission.)

4. If you are having problems with this online form, please contact Jenny Prosser at jprosser@leadingagemn.org or 651.603.3548.

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