IHI Open School Regional Leader Application

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* 1. Please share the following information:

Name

State/Province

Country

Email Address

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* 2. Please indicate your role below:

Student

Resident

Faculty

Health professional

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

Yes

No

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* 4. If yes, what is the name of your IHI Open School Chapter?

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* 5. I am applying for the Regional Leader position in the following region:

(US) Northeast

(US) Midwest

(US) Southeast

(US) Southwest

(US) West Coast

United Kingdom

Continental Europe

Canada

Latin America

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* 6. How many years, and in what capacity, have you been involved with the IHI Open School?

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* 7. Why do you want to be a Regional Leader?

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* 8. Do you have any ideas for improvement within your region? If so, please share them below: