Enter information below concerning a presentation you made either as a stand-alone offering or when you served as a main presenter at an invited event.  

A typical example would be a "Medical Overview" talk for the Alzheimer's Association - other Association staff may speak before or after you, but your talk is the main presentation on the disease process. Please do not enter presentations from conferences or university courses on this form. There are separate icons for these on the database home page.

Please fill in the requested information below. Most important fields are in RED.  Leave blank those fields that do not apply or for which information is not available. SUBMIT button at bottom.

Last Name of Presenter:  (e.g., Morris)

Date of Presentation: (e.g., 4/2/01)

Title of Presentation: 

Location of Presentation: (City, State and/or Country)

Host Organization: (e.g., Alzheimer's Association)

Co-Sponsor 1: (e.g., St. Louis Area Agency on Aging)

Co-Sponsor 2:  

Co-Sponsor 3:

Educational Emphasis: ADRC Tuesday Noon Seminar Minority Outreach / Recruitment Event Event for a LAY or Caregiver Audience Event for a PROFESSIONAL Audience Event Specifically for RURAL Lay Audience Event for Specifically for a RURAL Professional Audience Hands on Neuroscience Presentation for Children Other Presentation at WUSM Other (Explain in Comments)

Duration of Presentation (in hours):  (e.g., 2.5 equals two and a half hours)

Approximate Number in Attendance:                          Go to SUBMIT Button

_______________________________________________________________________
Optional:

Please estimate the % of individuals present 
from the following categories:                                                                                                 

African American       (% of total audience)

Lay / Caregiver                         (Together must add to 100%)
Physician                                  
Nurse                                        
Other Health Profession         

Adult                                          (Together must add to 100%)
Child - High School                 
Child - Middle School             
Child - Elementary School     

Did this event meet its educational and/or outreach goals? Yes No Somewhat

Were evaluation forms distributed?  No Yes Somewhat   

If Yes, what was the average overall quality rating? 

       (e.g., 4.23 on a 1-5 Scale; 5 = Excellent)

If applicable, please describe the funding/cost breakdown for this event in the box below.
(e.g., $5,000 Novartis Grant, $2,000 contributed by ADRC)

  

You are limited to 255 characters for each of these comment boxes. Use abbreviations when you can. If you have more to say than will fit, please e-mail this information to Tom Meuser, Education Director.

Other Comments: