Thank you for your interest in the SHM I-PASS Mentored Implementation Program. This survey serves as your application for participation in the program. Applications will be reviewed through February 8, 2016 and you will be notified whether you have been accepted into the program by approximately February 22, 2016.
Please note that the SHM I-PASS Mentored Implementation Program will primarily target institutions with resident physicians. We ask for commitment from participants and administrative leaders to implement the program interventions and collect the necessary data to monitor the impact of the program and interventions in a timely manner.
Again, thank you for your interest!
APPLICATION DUE DATE: February 8, 2016
Instructions for completing application:
Please answer the following questions completely but succinctly. Your entire team should assist in this process. “Unknown”, “None”, or “Not Applicable” responses are permissible – but be certain your entire team is in agreement before resorting to one of these responses.
**PLEASE NOTE: It is not possible to save work in progress on this application. Please make sure to have all responses prepared, and necessary information available prior to initiating the submission of your application.**
