IHI Open School Cultural Competency Expedition Application

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* 1. Please share the following information:

Full Name

Email Address

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* 2. Please indicate your role:

Student

Resident

Faculty

Health Professional

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* 3. Are you a part of an IHI Open School Chapter?

Yes

No

If yes, please share the name of your Chapter below:

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* 4. Why are you interested in participating in this training?

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* 5. Share an example of how you’d promote cross-cultural communication in a hospital setting:

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* 6. How do you plan to apply the skills and knowledge gained through this training to your Chapter work and beyond?

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* 7. Please indicate if you are available to join the training sessions at the following times:

	Yes	No
Thursday, March 9, 12:00 - 1:00 PM (ET)	Thursday, March 9, 12:00 - 1:00 PM (ET) Yes	Thursday, March 9, 12:00 - 1:00 PM (ET) No
Thursday, March 24, 12:00 - 1:00 PM (ET)	Thursday, March 24, 12:00 - 1:00 PM (ET) Yes	Thursday, March 24, 12:00 - 1:00 PM (ET) No
Thursday, April 7, 12:00 - 1:00 PM (ET)	Thursday, April 7, 12:00 - 1:00 PM (ET) Yes	Thursday, April 7, 12:00 - 1:00 PM (ET) No
Thursday, April 21, 12:00 - 1:00 PM (ET)	Thursday, April 21, 12:00 - 1:00 PM (ET) Yes	Thursday, April 21, 12:00 - 1:00 PM (ET) No
Thursday, May 5, 12:00 - 1:00 PM (ET)	Thursday, May 5, 12:00 - 1:00 PM (ET) Yes	Thursday, May 5, 12:00 - 1:00 PM (ET) No