CPD Instructor Bio – Appendix B

Course Name*

Note: This is used to pair this form submission to a master Course Approval Application submission, so please make sure the course name entered here is correct
Name*
First Last
Education*
Schools, Trainings, Apprentices
Degree (if applicable)
Date*
MM slash DD slash YYYY
Major or Field of Study*
Provide a brief explanation of your experience with the topic to be presented.*
Conference Presentations*
List up to 5 of your most recent conference presentations
Title of Presentation Date Sponsoring Group
Describe any relevant teaching experience
(Include institution/location, dates, responsibilities/course(s) taught).
List any publications such as books, general articles, peer reviewed articles, etc.
List any relevant research activities or grant support
List any other related experience or professional memberships

Title of Presentation	Date	Sponsoring Group