Annual Meeting Program Information & Grant Submission Form

Thank you so much for completing this submission for the annual meeting. The information you provide in this form will be used to develop the grant proposal. Our success in obtaining grants is based on the depth of information provided about each of the session. Please share as much detail as possible about the session and in particular what you think may be of particular interest to grantors. Thank you!

Please do not worry about formatting, as long as the text is complete, we will format everything as part of the grant proposal.

"*" indicates required fields

Your Name*

First Last

Your Email*

Chair Name*

First Middle Initial Last

Credentials*

Institution*

Co-Chair or Vice-Chair Name*

First Middle Initial Last

Credentials*

Institution*

Type of Session*

Symposium/Plenary

Interactive Lunch Workshop

Professional Development Workshop

Additional Lunch Workshop

Other

Title of Activity/Session*

Please provide the official title of the session. This will be copied exactly as typed here for the advanced and final programs, and related marketing materials.

Session Description

Please provide a description of this session, specifically why this topic is timely or important. Please include anything you think is important for the grant writer to include in the proposal (150-word count minimum). This will be copied exactly as typed here for the advanced and final programs, and related marketing materials.

Pharma/Medical Device Companies*

Please provide the names, and contact information if known, of any pharmaceutical or medical device companies that relate to your session. Please confirm these companies are accepting funding in the areas your session covers.

What makes this session of particular interest to sponsors?*

Gap Analysis
All grant-funded CME activities must be designed around a Professional Practice Gap, and we must be able to derive data from learners that outlines the degree to which we were able to close the gap in practice as outlined below.

What is the problem we need to solve? What would it look like if that problem was gone? Why does this gap exist? What are the factors contributing to this gap? This can include things we can change with our education (e.g., new techniques and skills) and also things we cannot change (e.g., government regulation).

Educational Need (of the target learners) / Learning Objectives*

Complete the following statements as a frame for the learning objectives.

FOR EXAMPLE: At the end of this session, attendees will be able to:
– Discuss the long-term outcomes and complications of pediatric epileptic encephalopathies, neuromuscular and mitochondrial disorders.
– Discuss the mechanisms of action and potential benefits of emerging therapies for these disorders.
– Assess the risks and benefits of new treatments for these disorders.

References/Evidence-Based Resources
Please provide at least 3 references.

Reference 1*

Reference 2*

Reference 3*

Reference 4

Reference 5