Shift-Results: Improvement Design Intensive Application
Please fill this form out about you and your organization. Once we receive your application, we will review it and respond. Thank you!
Your Name *
Your answer
Contact Information (Phone number and email) *
Your answer
Organization name *
Your answer
What does your organization do? *
Your answer
What dates are you interested in attending? *
Your Role
Your answer
How many team members will attend this workshop with you? (Reminder the workshop is $3,000 per person.)
Your answer
Team members who will attend and their roles: (Name, role, phone number and email)
Your answer
What experience with quality improvement methods do you and your team have? (Please include any past trainings or experience using quality improvement methods)
Your answer
Name of your improvement initiative:
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Why is this initiative important to your team right now?
Your answer
How did you hear about the Improvement Design Intensive?
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What do you hope to gain in attending this workshop?
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