Multidisciplinary Symposium Submission Form

Thank you for your interest in submitting a project for Community Health Network’s and UIndy’s Annual Multidisciplinary Scholarly Activity Symposium.

Submissions will be accepted November 1, 2020 through February 1, 2021.

We welcome your participation and look forward to reviewing the many great scholarly activities being pursued by you and your colleagues. If you have any questions about submissions, please email Kaylee Burget at kburget2@eCommunity.com.


CME Disclosure

All participants (entire project team) must return the electronic CME Disclosure Form before they can participate in the symposium.

Project Leads: Download the form and distribute to other project members.
Project Team Members: Return the completed form to the project lead, who will combine all team members' forms into one document to be uploaded with this submission.

  • Do not send individual forms for project members.
  • Save form with a unique file name that identifies the project lead or project title.

Download CME Disclosure Form

How to Return the CME Disclosure Form

Project Leads: Attach form to this submission or email as an attachment to kburget2@eCommunity.com. Remember, this should contain the disclosure forms for ALL of your project team members.
Project Team Members: Email your completed form to the project lead.

Maximum 10 files.
256 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Contact Information

Primary Contact

Name
Affiliation
Role

Additional People on Project

Include first and last name, credentials, email address and role for EACH person. Every field is required for each person added.

(Tip: Use the +/x controls to add or remove a person. Use the "Add Person" number selector to add multiple people at once.)

First Name Last Name Credentials Email Address Role Operations
Role

Project Details

Was this project submitted to the 2020 Symposium?
Project Category
Submission Category
Please list 3 references.
For oral presentations, please list 3 learning objectives. This is required.
For oral presentations, please list pre- and post- presentation questions. This is required.

IRB Information

IRB Submitted?

All presentations must be reviewed by an IRB OR have a non-human subject’s determination letter from an IRB Office prior to submitting. If you have not received written IRB approval - please contact your IRB Office at:

Which IRB reviewed the activity?
One file only.
256 MB limit.
Allowed types: doc, docx, pdf.