Global Health Program Advisory Service Needs Assessment

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1. Name: (Required.)

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2. Title: (Required.)

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3. Institutional Affiliation: (Required.)

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4. Email: (Required.)

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5. Telephone Number:

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6. Do you envision participating in this program as a... (Required.)

Advisee

Mentor

Both

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7. Please provide the following information about your current global health educational program:

Program or track name:

Program website (if available):

Year of program initiation:

Department or school responsible for the program:

Current number of participating faculty (or enter "unsure/unknown"):

Current number of participating trainees/students (or enter "unsure/unknown"):

Discipline(s) in the program:

Level(s) of trainees involved in the program:

Please provide a brief description of your program and tell us what you consider to be its defining characteristics:

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8. Which of the following problems or concerns would you like to address as part of this advisory service? (Please indicate ALL that apply) (Required.)

Program funding

Curriculum and/or teaching methods

Increasing program size

Development of new program features

Developing or strengthening overseas partnerships

Increasing and/or improving faculty involvement

Developing or improving field experiences

Increasing level of university support

Other (please specify below)

Other problems or concerns you would like to address:

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9. For advisees, please provide a brief description of the most important issues you wish to address in the coming year. (Include up to 3 areas you wish to work on and indicate in descending order the most to least important.) (Required.)

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10. For advisees, if you are to use the CUGH advisory service, please describe what 'success' will look like for you. (Required.)

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11. For mentors, please indicate which of the following areas you feel most comfortable in providing assistance. (Please indicate all that apply.)

Program funding

Curriculum and/or teaching methods;

Increasing program size;

Development of new program features

Developing or strengthening overseas partnerships

Increasing and/or improving faculty involvement

Developing or improving field experiences

Increasing level of university support

Other (please specify below)

Other areas you feel most comfortable providing assistance:

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12. For mentors, if you participate in the CUGH advisory service, what would a successful mentor-advisee relationship look like to you?

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13. For mentors, the minimum expected commitment includes regular telephone communication (preferable a monthly call), a site visit and a final report of recommendations. Do you feel you are able to provide this level of commitment?

Yes

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* 1. Name: (Required.)

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* 2. Title: (Required.)

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* 3. Institutional Affiliation: (Required.)

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* 4. Email: (Required.)

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* 5. Telephone Number:

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* 6. Do you envision participating in this program as a... (Required.)

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* 7. Please provide the following information about your current global health educational program:

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* 8. Which of the following problems or concerns would you like to address as part of this advisory service? (Please indicate ALL that apply) (Required.)

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* 9. For advisees, please provide a brief description of the most important issues you wish to address in the coming year. (Include up to 3 areas you wish to work on and indicate in descending order the most to least important.) (Required.)

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* 10. For advisees, if you are to use the CUGH advisory service, please describe what 'success' will look like for you. (Required.)

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* 11. For mentors, please indicate which of the following areas you feel most comfortable in providing assistance. (Please indicate all that apply.)

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* 12. For mentors, if you participate in the CUGH advisory service, what would a successful mentor-advisee relationship look like to you?

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* 13. For mentors, the minimum expected commitment includes regular telephone communication (preferable a monthly call), a site visit and a final report of recommendations. Do you feel you are able to provide this level of commitment?

1. Name: (Required.)

2. Title: (Required.)

3. Institutional Affiliation: (Required.)

4. Email: (Required.)

5. Telephone Number:

6. Do you envision participating in this program as a... (Required.)

7. Please provide the following information about your current global health educational program:

8. Which of the following problems or concerns would you like to address as part of this advisory service? (Please indicate ALL that apply) (Required.)

9. For advisees, please provide a brief description of the most important issues you wish to address in the coming year. (Include up to 3 areas you wish to work on and indicate in descending order the most to least important.) (Required.)

10. For advisees, if you are to use the CUGH advisory service, please describe what 'success' will look like for you. (Required.)

11. For mentors, please indicate which of the following areas you feel most comfortable in providing assistance. (Please indicate all that apply.)

12. For mentors, if you participate in the CUGH advisory service, what would a successful mentor-advisee relationship look like to you?

13. For mentors, the minimum expected commitment includes regular telephone communication (preferable a monthly call), a site visit and a final report of recommendations. Do you feel you are able to provide this level of commitment?