2018 ATSA Student Clinical Case and Data Blitz. Application Form & Instructions. Deadline: 11:59 PM on April 30, 201
2018 ATSA Student Clinical Case and Data Blitz Application Form & Instructions ______________________________________________________________________________ Deadline: 11:59 PM on April 30, 2018 Please email all completed applications to:
[email protected] Direct any questions to
[email protected] CLINICAL CASE SUBMISSION Requirements: • Must be a current graduate or undergraduate student • Currently being supervised by a licensed professional • Presentation will be a maximum of 5 minutes. Application requirements: • Abstract (250 words) describing the clinical case to be presented • Clinical case information must be stripped of identifying information. • Clinical case must not be identifiable from the media. • Student must have supervisor’s permission to present the clinical case (see attached form). _________________________________ DATA SUBMISSION Requirements: • Must be a current graduate or undergraduate student • Presentation will be a maximum of 5 minutes. • Must be research that will not be presented again at the ATSA conference. Application requirements: • Abstract (250 words) describing the research to be presented • Student must have supervisor’s permission to present the research (see attached form). _________________________________ All submissions should be focused on a clinical case or data related to the understanding, prevention, assessment, management, or treatment of sexual violence. Applicants will be notified by the end of May 2018 if they are selected to present at the ATSA conference.
CLINICAL CASE AND DATA BLITZ - APPLICATION FORM Student Information Name: Highest degree held: Academic Institution or Affiliation: Name of Program: Degree Expected/Anticipated Date of Graduation: E-mail Address: Telephone Number: Mailing Address: Supervisor’s Information Name: Degree: Institution: E-mail Address: Telephone Number: Mailing Address:
Please select one of the following:
Data Submission Abstract (250 words):
Clinical Case Submission
Clinical Case Presentation: 1. Case will be stripped of all identifying information 2. Case will not be identifiable from the media 3. The student presenting the clinical case has their clinical supervisor’s permission to present the case during the ATSA clinical case and data blitz on Thursday, October 18th or Friday, October 19th, 2018. The final date will be announced June 2018.
_______________________ Student signature
_________________________ Date
_______________________ Supervisor’s signature
_________________________ Date
Data Presentation: 1. The student presenting the data has their clinical supervisor’s permission to present the the case during the ATSA clinical case and data blitz on Thursday, October 18th or Friday, October 19th, 2018. The final date will be announced June 2018.
_______________________ Student signature
_________________________ Date
_______________________ Supervisor’s signature
_________________________ Date
