Healthcare Education Learning Project (HELP) Form

Healthcare Education Learning Project (HELP) Form

Note: For patient education requests, please use the Patient Education Advisory Council intake form.

The Learning Design and Systems (LDaS), the Simulation-Based Education and Research (SBER), and the Office of Employee Development (OED) teams support educational initiatives that benefit the Dartmouth Health System. These resources can be requested for any clinical or non-clinical learning need by completing the requested information below.

Name*

Email*

Unit/Dept/Division*

At which organization are you an employee?*

Select

External Organization*

Is this an update to an existing learning activity?*

Select

Title of Learning Request*

Briefly describe the changes you would like to make:*

Who did you previously work with to design this module (Select all that apply)*

Select

Please specify the other designer*

Indicate the reasons for this project (Select all that apply)*

Select

Other Reason for the Request*

Briefly describe the request with emphasis on the problem you are looking to solve*

Does this request pertain to a regulatory, compliance, accreditation, or certification requirement?*

Select

Is this request connected to existing or future research activity?*

Select

From which regulatory, accrediting or certifying body does the requirement issue*

Is this an interprofessional learning activity?*

An interprofessional learning activity is an activity that is planned, delivered by, and intended for individuals representing two or more different professions (e.g. Nurse, Physician, Pharmacist, APP, Social Worker, etc.)

Select

Who is the target audience for this education? (Select all that apply)*

Select or enter value

Which clinical staff do you plan to target?*

Select

Please describe the other clinical staff you plan to target*

Alternative Audience*

Would you like to consider applying for continuing education credits for this activity?*

Continuing education credits are awarded for attending educational activities that may be required for health professionals to maintain their licenses.

Access the Accreditation form

Select

Subject matter expert(s) (SME) name(s) (if different from the person completing this form)

A Subject Matter Expert is an individual(s) who will be providing content knowledge and expertise on the topic for this activity.

SME Email(s) (if different from the person completing this form)

Will this project require approval from additional stakeholders prior to implementation?*

Select

Any other helpful information you would like to share?

Please upload any relevant supporting documentation here

Drag and drop files here or

Send me a copy of my responses

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