New York Mental Health Counselors Association

Continuing Education Presenter Application

Lead Presenter Name:
Degree and Credentials:
Title:
Organization/University/Agency:  (List all that apply)
Mailing address:
City/State/Zip:
Phone:
Email:
Description of presentation:    Presentation must include references to current research on your topic.
                             

   As required by the New York State Department of Education, please submit the 
   following  by email  with your completed form:

     - A CV that documents your preparedness and experience in presenting on your topic.           Send your CV in the following formats:  PDF, DOC or DOCX.  Do not send a JPEG.


 Questions?  
Additional Presenter Name:
Degree/Credentials:
​2nd Presenter - Organization/University/Agency: (List all that apply)
Title:
City/State/Zip:
​2nd Presenter Mailing Address:
2nd Presenter Phone:
2nd Presenter Email:
* Your application will be forwarded to our continuing education committee for their  
   review and approval.  They will contact you if they have questions and in regard to 
   the status of your application.
Do you have a location, date and time scheduled for your proposed workshop?  If so...........
Location:  (If NYMHCA Regional Chapter, state which one)
Date:
Start time:
Length of Presentation:

Will this workshop be:    (Choose all that apply)
~  a single workshop or event?
 ~  the first in a series of workshops with a unified theme?
 ~  a NYMHCA Convention workshop?
 ~  a live in-person webinar?
~  Other?  Please explain.
  Please provide us with at least 3 learning objectives for your presentation. Each objective should begin  
  with "After this workshop, participants will....."
Here is the list of acceptable content for continuing education presentations for LMHC's as defined by the 

NYS Education Department:        (Choose as many as applies)

I hour of presentation = 1 contact hour (CEU)
Please describe the teaching methods you will use.  For example: Powerpoint, overhead projector, printed materials, group interaction, lecture, practice demonstrations, etc.  And tell us of AV needs for your presentation.
End time:
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~  same workshop/same content given multiple times?
Presentation Title:
ie., DBT, Play Therapy, etc.
ie., CBT for Trauma Therapy, etc.
from medicine, law, administration and education
related to mental health counseling practice
which contribute to professional practice in mental health counseling and the health, safety and/or welfare of the public
 ~  a presentation given by an independent presenter or organization?
 ~  a presentation given for a NYMHCA regional chapter?
Clinical Intervention:
Evidence Based Practice:
Cross Disciplinary Offerings:
Behavioral and Social Sciences:
Record Keeping
Matters related to law or ethics:
Patient Communications