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

Address

Phone day ( ) eve ( ) Fax ( )

E-Mail: Web:

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)