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Faculty Information Form for 2015 Geriatrics Update

All faculty with speaking roles at the 2015 Geriatrics Update will need to complete this form.

You cannot save and return later, so please wait until you are prepared to complete the entire form to begin.

You will need to be prepared to provide the following to complete the form:

  • Your CV
  • A brief bio
  • Any potential Conflict of Interest you might have
  • List of objectives for your talk (didactic lecturers only; panelists do not need to submit objectives)
  • List of topics to be covered  (didactic lecturers only; panelists do not need to submit topics)

Step 1 of 3

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  • Please list your administrative assistant's name and contact information (if applicable)

  • (###)###-####
  • Please upload your most current CV/resume
    *Off-label use is the practice of prescribing pharmaceuticals or devices for an unapproved indication or in an unapproved age group, unapproved dose or unapproved form of administration.
  • UAMS is encouraging course directors to incorporate planning by the health care team for the health care team to produce interprofessional education. We have identified the following targeted learners for this activity: Healthcare professionals working with the elderly population, including physicians, nurses, dietitians, social workers, nursing home administrators, certified medical directors, pharmacists and other allied health care professionals. If there are any other learners for whom you feel your presentation would be relevant, please list them above.
  • Nursing accreditation requires that you provide scholarly references. Professional association websites, or generally applicable articles are fine. List DOES NOT have to be all-inclusive of everything consulted for your talk. If you include references in your presentation slides, you may skip this field.
  • If you prefer, you may upload a file with your references. If you have listed references above, or if you plan to include them in your slides, you may disregard this.


  • Please list a minimum of 3 objectives per credit hour of presentation.

    Remember learning objectives must be consistent with the above activity type and must be measurable. If your target audience includes both pharmacists and technicians, you must write separate objectives for both audiences that apply to their scope of practice.

    (*Verbs to AVOID while writing objectives: appreciate, enjoy, really understand, be acquainted with, fully appreciate, realize, be aware of, grasp the significance of, remember, be familiar with, sympathize with, believe, know, understand, comprehend, learn)

  • Please list learning objectives for your presentation.
  • Give a general overview of the content (i.e. key points) your presentation will address. These should be more extensive than your objectives, and can be simply a list of content points to be covered rather than complete statements.
  • This should include experience that is relevant to THIS talk.
  • Please describe any audio visual requirements you will have for your presentation.