New York Mental Health Counselors Association

Continuing Education Presenter Application

Lead Presenter Name:
Degree and Credentials:
Organization/University/Agency:  (List all that apply)
Mailing address:
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 (resume) that documents your preparedness and experience in presenting on your topic. 
       Send your CV/resume in the following formats:  PDF, DOC or DOCX.  Do not send a JPEG.

Additional Presenter Name:
​2nd Presenter - Organization/University/Agency: (List all that apply)
​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)
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:
Contact Us
~  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?
Please provide a 2 sentence description of your workshop to be used for advertising purposes:
*Please do not click on the button to submit your application before uploading your resume or CV!
Would you be willing to record a video of yourself describing your workshop and what attendees will learn and experience?  

       - You can use your cell phone and the  video should be no longer than 5 minutes.  It will be posted on the NYMHCA 
         YouTube channel and we will place a link to the video next to the posting of your workshop on our webpage.

        If you answered yes, you will be contacted and given instructions for submitting your video once your proposal has been approved.
Clinical Intervention:
Evidence Based Practice:
Cross Disciplinary Offerings:
Behavioral and Social Sciences:
Record Keeping
Matters related to law or ethics:
Patient Communications
Yes I will do a videoNo video