Last revised September 2020

Submitted by:

Representing (organization): Contact information (Name): Email:
Mailing address:
Date submitted: Month, date, Year
Skype name:
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Please tell us about the type of workshop you would like to hold:
How many speakers or topics does your group desire?
Are there specific desired topics? (e.g., 3 sessions consisting of one preschool, one school-aged and one adult focus; research skills, evidence-based practice, counseling, advanced clinical skill development, etc. )?
Are you interested in specific speakers, such as IFA volunteer experts (please go to: http://www.theifa.org/about-us/ifa-experts/ifa-expert-list)? Please specify and we will attempt to facilitate programming for your group.
Will your group also contribute sessions or speakers to this event?
Proposed duration of workshop (over how many hours/days do you request programming?):
Proposed date(s) of workshop:
Proposed location (Event name, venue and city)
Proposed number of attendees:
Please specify background of attendees (nationalities, as well as whether they will be researchers, clinicians, consumers or other):
If your group is not selected for an onsite workshop at this time, could this workshop be offered as an interactive distance activity (two-way classroom/Skype)?
If so, where might the event be hosted locally? (e.g., local university, medical center two-way classroom)
The official language of the IFA is English. Presenters will present in English unless otherwise arranged. We will presume that interpreting, if necessary, will be provided by your organization. If you request an instructor in a specific language, please provide details and will attempt to meet your needs.

Budget details

The IFA requests matching funds if at all possible, and will also facilitate discussions with other potential funders of your activity. Your responses help us to estimate costs to the IFA as well as to any of its co-sponsoring organizations.
Will your group charge for attendance at this event? If so, please estimate participant registration fees that can be applied against budget details on the next page.
Is your organization able to partially support in any of the following ways? (please specify maximum amounts):
15
Type of event expense
Venue cost (room rental, AV) Speaker honoraria*
Speaker travel
Speaker housing
Speaker meals
Speaker local transportation Materials and copying Workshop refreshments
Advertising
Maximum available matching funds or local arrangement
Other contributions (please specify)
ESTIMATED REVENUE from participant registration fees
TOTAL AVAILABLE HOST CONTRIBUTION
* In case there is a request for speaker honoraria, the IFA is prepared to fund speaker’s fees up to 1000 US$ per speaker depending on the budget information provided by the workshop organizers.

Please note the following:
The requesting organization must take full responsibility for all local arrangements such as venue contracts, mailing of materials, registration, refreshments for attendees, etc. If the speaker(s) will need help in obtaining a visa or other work permit, your group will be asked to facilitate this process. Speaker travel may be arranged by the IFA or one of its participating co-sponsors.

Please return this form to:
Kurt Eggers, President-Elect This email address is being protected from spambots. You need JavaScript enabled to view it. Shelly Jo Kraft, Treasurer This email address is being protected from spambots. You need JavaScript enabled to view it.