Fillable EW PROGRAM N REQUEST FORM Introduction Continuing Education (The Michener Institute of Education at UHN)

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EW PROGRAM N REQUEST FORM Introduction Continuing Education (The Michener Institute of Education at UHN)

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N
EW PROGRAM
REQUEST FORM
Introduction
Continuing Education (“CE”) at the St. Patrick Campus of the Michener Institute of Education at UHN
offers diverse learning opportunities, including graduate certificates, specialized courses, and
workshops, with many available in flexible, online formats. We are constantly evolving our range of
offerings to meet health system needs locally, nationally and globally. We look forward to exploring your
recommendation for a new learning opportunity. To help us get started, please consider the questions
included in the sections below.
Overview of process:
1. Those proposing the program complete this form and submit it to their point of contact in CE
(“CE contact”).
2. The CE contact will work with the program requestor to determine the viability of the requested
program.
3. If and when the program is deemed viable, CE will move into program development and
implementation in collaboration with the program requestor.
Section 1: Contact Information
Name
Email
Phone
Name of CE Contact
Have you had any previous contact with Michener regarding this course? If so, with whom and when?
Section 2: Suggested Learning Opportunity
Topic
Preliminary Title
Why is this course needed at this time? What gap will be addressed?
What is currently being done in practice to address this gap? (example: on the job training)
N
EW PROGRAM
REQUEST FORM
Who do you anticipate taking this course?
Education Level (undergrad, grad)
Designation (RRT, RN, MD, etc)
What key learning outcomes are anticipated?
Should a credential be awarded? If so, please identify which credential.
How long do you think this course should be?
What are your thoughts on how this course should be delivered (e.g. full time, part time, workshop,
etc.) Please explain why.
Thank you very much for your program suggestion and for taking this time to provide us with
the information we need to assist us in program decision making.
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EW PROGRAM N REQUEST FORM Introduction Continuing Education (The Michener Institute of Education at UHN)

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Completed 10 February 2021

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