Your Information *First Name *Last Name *Site *Site Bayonne Clifton East Brunswick Egg Harbor Township Fanwood Hamilton Mountainside New Brunswick - Plum Street New Brunswick - Somerset Street Newark Roselle Park Toms River - Lakehurst Rd. Toms River - Stevens Rd. Union *Department *Department Administration Ambulatory Care Audiology Autism Business Development Business Program Development Admin Case Management Case Management Part H Child Care Cognitive Remediation Dietary Education EIP Family Centered Care Feeding Program Finance LTC Therapies Medical Medical Day Care Nursing Administration Nursing LTC Nursing Rehab: Adolescent Unit Nursing Rehab: Infant Toddler Unity Nutirion Occupational Therapy Opportunity Project Other PAS Patient Care Coordination Pharmacy Physical Therapy Psychology Recreational Therapy/Child Life Rehab Technology Respiratory Speech Therapy Volunteers Wheelchair Sports Were multiple staff members involved in this event? If so, please list their information below Event Information *Name of Event *City *State *Country *Date of Event Type of Event *Type of Event *Type of Event Community Outreach/Engagement Community Education Professional Education Health Professional Education *Subcategory *Subcategory Health Fair Table at Community Event Bike Rodeo Hospital Event Other *Subcategory *Subcategory PTA Parent Group Charitable Organization Civic Organization Radio/TV Interview High School Students Other *Subcategory *Subcategory Lawyers Teachers Legislators Business organizations/groups Other *Subcategory *Subcategory Students Residentsh Doctors Nurses Psychologists Therapists Social Workers Other If Hospital Event or Other, please name event here *# People Served *Description of Event *Goal of Event If this was for a publication, please complete the following Title of Article Journal Title Brief Synopsis Issue Year Title of Book (if applicable) Title of Chapter (if applicable) # Hours Spent *Preparation/Research *Organizing *Writing *Presentation *Travel Expenses *Expenses paid by CSH YesNo Car Mileage (Roundtrip) Train Fare Airfare Car Services Parking Hotel Meals Shipping Cost Other