International Muslim Mental Health Conference
October 20, 2018 ~ Amman, Jordan
Michigan State University, Common Bond Institute,
International Humanistic Psychology Association,
International Federation of Medical Student Associations-Jordan
Presenter Proposal Form
( * DUAL PROGRAM: Do you wish this proposal to also be considered for the programmatically linked 7th Annual International Conference on Transgenerational Trauma, occurring at the same site on October 18-19 and sponsored by the same organizations? YES ___ NO ___)
This form can be copied & pasted into an Email to complete & submit
(PLEASE TYPE OR PRINT CLEARLY, AND SUBMIT IN PLAIN TEXT FORMAT TO ALLOW FOR EASY EDITING)
1. Name & Credentials
Phone day ( ) eve ( ) Fax ( )
2. Workshop/Presentation Title (for printed program – max. 12 words):
3. Workshop/Presentation Brief Description (for printed program – max. 45 words). Please be clear and direct about what you are going to do:
4. Relevance To Conference Topic And Mission: Please indicate how your presentation is relevant to the topics: “Muslim Mental Health” and Global Mental Health,” as well as how it advances understanding, treatment, prevention, and public dialogue and awareness of these (use additional paper if needed):
5. PLEASE NOTE: The MMH Conference is an interdisciplinary event meant to build learning and a productive dialogue toward outcomes and concrete applications. As a result we ask all selected presenters to be with us for the full conference. This is an important factor in selection. (Presenters receive a 20% Discount off the Program Fee).
Will you be participating throughout the conference? ______
6. Theme Category: Please indicate which theme(s) your session most closely relates to (check all that apply):
[ ] Psycho-Social, [ ] Trauma informed, [ ] Cultural and Faith-based,
[ ] Humanitarian Response, [ ] Migration, Resettlement, and Integration,
[ ] Educational, [ ] Peace Activism, [ ] Global Relations, [ ] Public Policy & Law,
[ ] Other ________________
7. Session Format (Important Note: The MMH Conference is an interactive event to promote the most shared learning and pro-action. All presenters are asked to include interaction and direct attendee participation where possible). Check all that apply:
[ ] Skills [ ] Demonstration [ ] Roundtable/Panel [ ] Discussion/Dialogue
[ ] Experiential [ ] Lecture/Research [ ] Multimedia
8. Personal/Professional Bio Statement (for printed program – max. 75 words).
Please include credentials/degrees, occupation, and any position. Also include (separately) a current brief resume. *We prefer not to edit longer personal bios, so appreciate keeping within the word limit.
Co-presenters: If you have co-presenters please also include their name and information:
9. Continuing Education Credits: Will presentation be structured to meet CEC requirements?:
[ ] Yes [ ] No
10. Any Equipment Needed: _____________________________________
11. If you are a licensed practitioner, has your professional license or insurance ever been on probation, suspended, or revoked?
[ ] Yes [ ] No If yes, please explain on a separate sheet.
12. TAPING: Conference sponsors periodically tape or photograph presentations for professional use. Please indicate if this is not agreeable (if not indicated it is assumed to be agreeable):
[ ] I Agree [ ] I do not Agree
13. A collection of ARTICLES submitted by conference presenters relevant to their presentations is being generated for publication in a virtual journal on our web site. Submissions in advance are requested. Guidelines are provided on request. Would you wish to contribute such an article?
[ ] Yes [ ] No
14. ADDITIONAL REQUESTED INFORMATION (*please submit proposal in plain text form to allows for easy editing):
[ ] Full Presentation Description: (approx. 200 – 300 words on separate sheet, with
description of qualifications and familiarity with the subject)
[ ] A Current Brief Resume for all presenters and co-presenters
[ ] 2 Professional References (names, position, relationship, & contact info.).
Please include E-mail, as well as phone/fax and mailing address.
[ ] When We Can Reach You (best days and times)
15. Opportunities are available to cooperate in a Global Network of professional groups studying communal and transgenerational trauma, organized by Common Bond Institute.
Are you associated with an existing professional Study Group that addresses this issue?
[ ] Yes [ ] No
If so, what group and country (organization, professional group, etc.):
If not, are you interested in forming or joining a study group? [ ] Yes [ ] No
Submission Date By: September 15, 2018
NOTE: Early submission is highly recommended
to ensure consideration for the limited number of session openings
Please submit proposals (in plain text and with no imbedded formatting) by E-mail to:
Common Bond Institute
Attn: Steve Olweean, Director, Conference Coordinator
12170 S. Pine Ayr Drive, Climax, MI 49034 USA
Ph/Fax: 269-665-9393 Email: SOlweean@aol.com
Details at Website: www.cbiworld.org/conferences/mmh/
(* This form can be copied & pasted into an Email to complete & submit by Email. If Email is not possible you may submit by land mail or fax)
See Posted Guidelines for Proposals
* Proposal questions contact Dr. Farha Abbasi, MD at: Farha.Abbasi@hc.msu.edu
(Presenters receive a 20% Discount off the Program Fee)