Application form 2022

APPLICATION TEAM FORM

Fill in the form below with your organisation’s and team members’ information to pre-register for this 2022 edition course.

You are kindly advised to use this template beforehand completing this registration form

 

(Please enter:

  1. the high-level description of the experienced issues and felt needs your team would like to work on during the training;
  2. how the experienced issues and felt needs are impacting the healthcare delivery of your service/unit/healthcare organization/etc.;
  3. the expected outputs/outcomes once they are addressed (eg.: reduction of mortality rate, increase of quality of life, reduction of waiting list, improvement in health outcomes, etc.);
  4. the identified entities/stakeholders affected by the experienced issues and felt needs;
  5. the high-level description of the state of the art to demonstrate that the identified problem, issue, need is unmet.

)

* compulsory

Participant 1

(Please provide your English level oral and written, and highlight any work experience, research project, article you published, study you performed, etc., relevant to the problem, issue, need identified by your team, your state role in the organization and your experience with innovation)

(Please enter your perspective on the problem, issue, need identified by your team, describe how they are influencing your currently way of doing and how it would impact your work if addressed)

(Please explain why you join together, what is the support you have from the organization or any other issue that you consider interesting to share with us)


Participant 2

(Please provide your English level oral and written, and highlight any work experience, research project, article you published, study you performed, etc., relevant to the problem, issue, need identified by your team, your state role in the organization and your experience with innovation)

(Please enter your perspective on the problem, issue, need identified by your team, describe how they are influencing your currently way of doing and how it would impact your work if addressed)

(Please explain why you join together, what is the support you have from the organization or any other issue that you consider interesting to share with us)


Participant 3

(Please provide your English level oral and written, and highlight any work experience, research project, article you published, study you performed, etc., relevant to the problem, issue, need identified by your team, your state role in the organization and your experience with innovation)

(Please enter your perspective on the problem, issue, need identified by your team, describe how they are influencing your currently way of doing and how it would impact your work if addressed)

(Please explain why you join together, what is the support you have from the organization or any other issue that you consider interesting to share with us)


Participant 4

(Please provide your English level oral and written, and highlight any work experience, research project, article you published, study you performed, etc., relevant to the problem, issue, need identified by your team, your state role in the organization and your experience with innovation)

(Please enter your perspective on the problem, issue, need identified by your team, describe how they are influencing your currently way of doing and how it would impact your work if addressed)

(Please explain why you join together, what is the support you have from the organization or any other issue that you consider interesting to share with us)


Participant 5

(Please provide your English level oral and written, and highlight any work experience, research project, article you published, study you performed, etc., relevant to the problem, issue, need identified by your team, your state role in the organization and your experience with innovation)

(Please enter your perspective on the problem, issue, need identified by your team, describe how they are influencing your currently way of doing and how it would impact your work if addressed)

(Please explain why you join together, what is the support you have from the organization or any other issue that you consider interesting to share with us)

The training fee is 3500 Euro per team (VAT excluded). This amount can be reduced if you get a discount code (in that case, please introduce it in the discount code box). The fee includes training programs, study materials, mentoring and networking tools. Once your register has been approved (feedback will be provided in less than 10 days from your application after checking that you fulfil the criteria to get the best from the course), you will get a proforma invoice.

You are kindly asked to proceed with the payment within 30 working days from the receipt of the proforma invoice via bank transfer (or credit card – Visa/Mastercard). Please refer to the guide for applicants for more detailed information.