IHI Open School Global Chapter Leader Application Question Title * 1. Contact Information Name City/Town State/Province Country Email Address Phone Number Question Title * 2. Role (select all that apply) Student Resident/Junior Doctor/Fellow University professor Professional working in health care Professional working in another field Other (please specify) Question Title * 3. Profession/ Area of Study: Allied Health Professions Business Dentistry Engineering Healthcare Administration Health Informatics Health Policy Health Science Law Medicine Midwifery Nursing Occupational Therapy Pharmacy Physical Therapy Physician Assistant Public Health Social Work Other (please specify) Question Title * 4. Year of Graduation, if applicable: Question Title * 5. Please share which of the following IHI Open School courses and certificate programs you have completed: OS 101: Introduction to the Open School Leadership and Organizing for Change (I-CAN) QI 301: Quality Improvement Practicum Basic Certificate in Quality and Safety Question Title * 6. Are you or were you recently involved in an IHI Open School Chapter? Yes No Other (please specify) Question Title * 7. If you answered yes, what is the name of the IHI Open School Chapter in which you are/were involved? Page1 / 3 33% of survey complete. Next