NCHengage Clinician Speaker Interest Form
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Department/Specialty
*
Credentials/Title
*
About You
Please attach your bio below.
*
Browse Files
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of
Please attach your most up-to-date headshot.
*
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of
What do you enjoy most about being a clinician at NCH? Your response will help us to better understand your passion, approach to care, and connection to the community.
*
Are you currently in good standing with NCH and eligible to participate in external community engagement activities?
*
Please Select
Yes
No
Presentation Details
*Please note that most opportunities occur during daytime business hours or in the evenings. These engagement activities are not compensated.
What topics are you interested in presenting on? Select all that apply.
*
Preventative Health & Wellness
Heart Health
Orthopedics & Fall Prevention
Women's Health
Men's Health
Nutrition & Healthy Living
Behavioral & Mental Health
Healthy Aging
Fitness & Mobility
Healthcare Technology & Innovation
NCH's Clinical Advancements & Accolades
Understanding Hospital Flow & Patient Care Processes
Emergency Preparedness & When to Seek Care
Other
Which audiences are you comfortable presenting to? Select all that apply.
*
Community Organizations
Homeowner Associations (HOA)
Senior Living Communities
Corporate/Professional Groups
General Public
Patient Support Groups
Healthcare Professionals
Supporters of NCH
Other
Preferred presentation length:
*
15-20 minutes
30 minutes
45-60 minutes
Panel Discussion
Q&A Format
What is your general availability for participating in outreach activities?
*
Please Select
Evenings Only
Daytime Availability
Flexible- available for both daytime & evening
Limited Availability
Do you have previous public speaking or presentation experience?
*
Please Select
Yes
No
If so, please briefly describe:
Is there anything else you would like the NCHengage team to know?
Thank You
Thank you for your interest in supporting community engagement and education through NCHengage. A member of our team will review your submission and reach out as speaking opportunities become available.
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