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Community QI Collective Cohort 3 Application
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Community QI Collective Cohort 3 Application
QI Collective Cohort 3
Please complete this form to express you/your team’s intent to participate in wave three of the Community Quality Improvement Collective, and to help guide you in your project selection.
Step
1
of
4
25%
Organization Details
Name of Organization
(Required)
Team Details
Team Member 1
Name
(Required)
First
Last
Preferred Name
Position Title
(Required)
Phone
(Required)
Email
(Required)
Team Member 2
Name
First
Last
Preferred Name
Position Title
Phone
Email
Team Member 3
Name
First
Last
Preferred Name
Position Title
Phone
Email
Team Member 4
Name
First
Last
Preferred Name
Position Title
Phone
Email
Program/project sponsor
Who will sponsor your participation in this program?
(Required)
Within the Community QI Collective, a sponsor refers to someone who will assist reducing barriers to implementation within your organization or group. They may provide time-relief for you to attend the sessions or work on the project.
Project details
Quality Improvement projects are best formulated around a specific area you want to seek improvement. It could be an area that is not working well, or it could be somewhere that is functional, but you think could be even better. With that in mind, when answering the below questions please try to think of the area you are wanting to apply a quality improvement project to, rather than providing a solution to the problem.
Please tell us about the project/focus area you plan to work on within the Community QI Collective.
(Required)
How does your project/focus area impact child and youth mental health and wellbeing?
(Required)
Familiarity with quality improvement
The following questions will help the program facilitators ensure the content meets the needs of all participants:
On average, what is your/your team’s level of familiarity with Quality Improvement?
(Required)
Please select one
Very famliiar
Somewhat familiar
Somewhat unfamiliar
Very unfamiliar
What areas are you looking to gain more knowledge in? (select all that apply)
(Required)
How to measure change
How to implement change
How to set up a QI project
How to engage community voice
Utilizing data to tell a story
Utilizing data to understand when a change was successful
Planning for scaling improvement
Leading QI projects
QI tools to analyze data
What do you hope to gain from the Community QI Collective (e.g., specific knowledge, tools, etc.)?
(Required)
How would this program benefit your organization?
(Required)
Setting up for success
The next questions help to ensure we provide all the necessary support so you can be the most successful in this program.
What type of support do you anticipate needing to successfully complete this program?
(Required)
Please indicate which of the following you are comfortable using:
(Required)
Zoom
WebEx
Excel
Microsoft Office
Moodle
Mural
None
I agree that, if accepted into the program, my name, organization name, organization logo, and images of myself can be used in promotional materials on the Community QI Collective web page, social media posts, and other promotional materials.
I agree
