EmailMe Form - 2023 Call for Presentations

FLORIDA STATE CONTINUING EDUCATION INSTRUCTOR CERTIFICATION QUESTIONNAIRE

Please indicate which of the following options best represents your current status as a Florida certified continuing education instructor. *

a) I am approved and certified

b) I have applied to present the topics indicated below and am awaiting approval

c) I am a DFS employee but will be presenting with a Florida approved instructor

d) I am not an approved instructor, but will be presenting with a Florida approved instructor

e) I have not yet applied

If you answered (a) above, please enter your instructor number.

***If you have not applied and you’re not presenting with a FL approved CE instructor, please close this page and follow the instructions on the Speaker’s page to apply for FL CE certification. Once you have a FL CE instructor number, please complete this Call for Presentation application.***

SPEAKER INFORMATION

Name *

First Last

Company/Firm Name *

Your Professional Title/Position/Rank *

Business Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Email *

Business Phone *

### - ### - ####

Cell Phone *

### - ### - ####

PRESENTATION INFORMATION

Presentation Title *

Topic Area of Presentation *

Presentation Level *

Introductory

Intermediate

Advanced

Course objective (75 words or less) *

Brief Description of your Presentation (1 paragraph - 100 words or less) *

Is this Presentation eligible for accreditation as
the 4-hour Law & Ethics update? *

Yes

No

Your Presentation's Intended Audience (If not selecting "All Attendees", please check all that apply). *

We will be applying for Florida insurance adjuster CE credits for this class. Please explain how this presentation would be relevant to an Florida insurance adjuster.

Is this a two-part presentation? *

Yes

No

Preferred session slot (time cannot be guaranteed, but we will try to accommodate) *

Second choice for session slot *

Third choice for session slot *

Would you consider presenting your class a second time during the conference? *

Yes

No

Perhaps

BACKGROUND INFORMATION

Speakers submitting presentation proposals may be subject to a background search to confirm that there aren’t any issues that would disqualify them as a potential speaker.

Professional license number (if applicable)

Has an administrative action ever been taken against you for violation of Statutes or Rules in Florida or any other state? *

Yes

No

Have you ever had any license suspended or revoked, whether in Florida or any other state? *

Yes

No

Have you ever been convicted or plead nolo contendere to a crime involving moral turpitude? *

Yes

No

If you have any question as to whether a crime involves moral turpitude, please reference the Department's webpage for additional guidance at the following links:

http://www.myfloridacfo.com/division/agents/licensure/general/priorcrimhist.htm
http://www.myfloridacfo.com/division/agents/licensure/general/DisqualifyingPeriods.htm

Have you ever been convicted or plead nolo contendere to a felony? *

Yes

No

If you responded “Yes” to any of the four questions listed above, please elaborate in this section:

CO-PRESENTER INFORMATION

Please indicate the number of co-presenters joining you. *

Please list the full names and titles of your co-presenters (if none, enter NONE) *

AUDIO/VISUAL REQUESTS

Every classroom WILL be equipped with a table and chairs for the speakers, an LCD projector and screen.

If you require additional equipment, please indicate below. If you prefer to bring your own projector, please mention that in the "Other" section.

You MUST bring your laptop or tablet to play your presentation. We WILL NOT provide laptops to speakers. We will provide the connectors for the laptop to the projector.

Please note that microphones will be provided in larger classrooms or as needed due to the subject matter or presentation format.

Additional equipment options *

Nothing additional needed

Flip Chart(s)

Large Rolling Table (medical examination classes only)

Podium

Wi-Fi Access (Please note the hotel may charge for this so only select it if you actually need it for your presentation).

Other

GRANT APPLICANTS

If you are a law enforcement official or state prosecutor, you may be eligible for one of a limited number of grants from FIFEC to attend the 2023 conference. Please indicate if you will be registering to attend the conference and applying for a grant.

Applying for a grant? *

Yes

No

DOCUMENT UPLOAD

Please use the following section to upload your Speaker's Agreement, resume or CV, and the timed class outline (Word .doc or .docx form only).

File Upload *

You can upload multiple items