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GHC Training and TA request form - for UC Davis use only
As part of GHC and UC Davis's partnership, we have designed this form specifically for you to request trainings, technical assistance, or attendance at meetings/conferences from us. Please complete all information to the best of your abilities.
Email address *
Primary contact for this event *
Your answer
Primary contact phone number: *
Your answer
Primary contact email: *
Your answer
Which department/collaborative is requesting the training/TA
Your answer
What's the requested date of the TA/training?
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Start time *
Time
:
End time *
Time
:
Are there alternative dates/times that could work as well?
Your answer
Description of the training or TA you are requesting (include learning objectives, purpose of convening, training goals etc): *
Your answer
Rationale for training/TA (ie, increase clinical competence, in response to adverse incident, etc): *
Your answer
Who is the audience or collaborative members (ie, medical students, residents, support staff, administrators, etc.) and approx # attendees?
Your answer
What is the typical method/format used in this training/meeting space? *
Your answer
Event location including address, building and room # *
Your answer
Parking instructions *
Your answer
Audiovisual Equipment: Will you provide: *
Do you need anything from the presenter ahead of time (a bio, GHC logo, outline etc)? What date do you need it by?
Your answer
Is there other relevant information you want us to know?
Your answer
A copy of your responses will be emailed to the address you provided.
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