New Diagnosis? Clarke Can Help!

Annual Mainstream Conference - Call for Proposals

Clarke Mainstream Services announces our 38th Annual Conference

October 19 & 20, 2017 | Best Western Royal Plaza Hotel, Marlborough, MA


"Supporting Listening, Language & Literacy in the Mainstream Classroom!"

Please complete the following form in order to be considered to present at the 2017 Annual Conference on Mainstreaming Students with Hearing Loss.

If you prefer, you can print/email the PDF form to: or fax it 413.586.6654.

Deadline for Submission: February 27, 2017

Please submit your proposal for Learning Lab Product Demo HERE.

Submitting a Workshop Proposal

Format: Presentation format will be a 90-minute Mini-Workshop - offered in the morning (10:30 - 12N) and repeated in the afternoon (1:15 - 2:45). This will allow sufficient time for an informative presentation including questions and/or discussion if needed.


1. Title of Proposal: (Successful titles convey the subject matter, pique the interest of the potential audiences)

2. Proposal Description: (Minimum 250 word description that will be shared with the planning committee)

3. Workshop Outline: (Include key issues to be addressed)

4. Primary Presenter:

Co-Presenter Information

(If there are additional co-presenters, please submit required information for each.)

5. Speaker Agreement:
If selected, presenters will be asked to sign a presenter agreement based on the following requirements:

  • Presenters receive a modest honorarium and are reimbursed (up to $250) round trip mileage or receive a travel stipend (up to $250) when traveling from out of state via train or air, plus hotel accommodations the night prior to their presentation at the conference hotel site. (Based on 1 presenter)
  • Each presenter will provide a brief biography along with their current CV/Resume.
  • Presenters must provide their own laptop for presentations.
  • Presenters are responsible for their meals, airport parking and ground transportation (i.e., shuttle, taxi, etc.).
  • If selected, presenters agree to send Clarke all presentation materials to by September 11, 2017. These materials will be shared with CART providers if access is requested in your workshop.
  • Copies: Each presenter is responsible for providing handouts necessary for their presentation. Clarke will notify you as to the number of participants registered for your workshop 2 weeks before the conference.

6. Presentation Learner Outcomes: (These outcomes must be included in our program applications for CEUs.)
Please list 3 learner outcomes that attendees will take away from your presentation. Learner outcomes should complete the following sentence: Upon completion of this workshop, the participant will be able to...


8. Content Level: (check one)

  • Introductory: Assumes that the participant knows little or no information within the presentation area covered, focus is “general orientation and increased awareness.”

  • Intermediate: Assumes that the participant has a general familiarity within the presentation area covered, focus is “increased understanding and application” by the participant.

  • Advanced: Assumes the participant has thorough familiarity within the presentation area covered, focus is “recent advances, future directions and application of research.”


10. Disclosure Forms
Please see below for Disclosure Explanations and Examples

ASHA Required Disclosures for All Presenters/Speakers

In compliance with American Speech-Language Hearing Association’s (ASHA) Continuing Education Board’s Requirements, Clarke Schools for Hearing and Speech requires that all presenters/speakers to disclose information regarding any financial and non-financial relationships related to course content prior to and during course presentations.

Disclosure Statements are REQUIRED on Your Opening PowerPoint Slides
Disclose any and all, real or potential conflicts of interest. Name any and all professional, financial or personal affiliation which may cause the impression that bias or prejudice could affect the objectivity of materials presented.

Relevant financial relationships are those in which the individual benefits by receiving intellectual property rights or a salary, royalty, gift, speaking fee, consulting fee, honoraria, ownership interest or other financial benefit. Financial relationships can also include “contracted research” where an institution gets the grant and manages the funds and the individual is the principal or named investigator on the grant.

Examples of relevant financial relationships may include:

  • Being an employee of, or a paid consultant to, an organization whose product or service you discuss in your presentation
  • Receiving grant funds for a research project you discuss in your presentation
  • Receiving royalties from the sale of a book whose content you discuss in your presentation

Relevant non-financial relationships are those that might bias an individual including any personal, professional, political, institutional, religious or other relationship. This may also include personal interest or cultural bias.

Examples of relevant non-financial relationships may include:

  • Serving as a formal advisor to a review panel
  • Sitting on the board of an organization whose product or service you discuss in your presentation
  • Receiving an award or honor from an organization whose product or service you discuss in your presentation

My Relevant Financial relationship disclosures are:

My Relevant Non-financial relationship disclosures are:

DEADLINE for proposals is Monday, February 27, 2017.
ALL relevant financial and non-financial relationship disclosures MUST be included.