TCP Coaching Credential Application, Level 1 - IHSSE

Team Coaching Credential Application

Description: Level 1 Coaching Credential (beginner) can be completed by a coach who has completed microsystem coach education and has coached one clinical or supporting microsystem for 5-12 months. Receiving credentials for the team coaching experience is a way Team Coaches can be recognized for their coaching capabilities.

Team Coaching Experience: 1 clinical or supporting microsystem for 5-12 months

Please complete this form to upload the following templates to apply for the Level 1 Team Coaching Credential:

1. CV or Resume (Click here for templates if needed https://chhs.unh.edu/resume-cover-letter)

2. Team Coaching Evaluation by Coachees Results Summary and Reflection Template (these findings should be included in the Personal Team Coaching Development Plan Template.)
3. Team Coaching Assessment and Development Tool (to assess your skills)

4. Review your pre/post Quality Improvement Assessment (QIA) instrument report from ImproveApp^TM to acknowledge accomplishments and identify skills you still need to develop.
5. Personal Team Coaching Development Plan Template (which includes #2,3,4 from above)

(all application fees are for 3 years)

*New CIT graduates will submit their CV or Resume and complete this application (all other documents were submitted in your Final Deliverables)

*Note your submissions must in a WORD or PDF format

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* First Name

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* Middle Initial

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* Last Name

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* Credentials (ie, MD, RN, MBA)

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* How do you wish your name to appear on your coach credential certificate?

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* Job Title

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* Organization

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* Phone Number

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* Email

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* Address

Street Address *

Street Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Country *

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* Are you renewing your TCP Coaching Credentials?

Yes

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* Did you complete the Team Coaching (previously known as eCoach-the-Coach) Program through The Dartmouth Institute Microsystem Academy?

Attended The Team Coaching Program

Attended a different coaching program

TCP Coaching Credential Application, Level 1 - IHSSE

Team Coaching Credential Application

Question Title

* First Name

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* Middle Initial

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* Last Name

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* Credentials (ie, MD, RN, MBA)

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* How do you wish your name to appear on your coach credential certificate?

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* Job Title

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* Organization

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* Phone Number

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* Email

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* Address

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* Are you renewing your TCP Coaching Credentials?

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* Did you complete the Team Coaching (previously known as eCoach-the-Coach) Program through The Dartmouth Institute Microsystem Academy?

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* If you completed the Team Coaching Program, what was your completion year?

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* If you completed a different coaching program, what was the name of that program?

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* Academic Affiliation

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* General Category of Interest

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* Specific Area of Microsystem Interest