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* 1. What is the name of your Chapter? (Please enter the full name of the university or organization.)

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* 2. In which region is your Chapter?

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* 3. Please tell us 1-3 things your Chapter has done or accomplished during the past year.

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* 4. Please tell us 1-3 goals your Chapter would like to work toward in the coming year.

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* 5. What additional support can the IHI Open School team provide you and your Chapter to achieve your goals? (e.g. help getting your Chapter started, curriculum reform, quality improvement projects, faculty engagement, etc.)

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* 6. Please provide any additional questions, comments, or suggestions you have.

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* 7. If there is more information you'd like to tell us about your Chapter, please feel free to continue to the second (and final) page of the survey. If not, we appreciate your time and look forward to supporting you in the coming year!

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