Vanderbilt Center for Advanced Mobile Healthcare Learning QuizTime Project Intake Form

Vanderbilt Center for Advanced Mobile Healthcare Learning QuizTime Project Intake Form

Thank you for your interest in working with Vanderbilt Center for Advanced Mobile Healthcare Learning's QuizTime! Please fill out the below form to the best of your ability and submit to the our office. If you have any questions, please contact support@quiztimehealth.com

Important Notice

A major upgrade is planned to roll out between May and June 2025. During this period, our team will be busy working on the upgrade. This may result in longer turnaround times (8-12 weeks) for quiz launch.

Client Details

Name:*

Department Name:*

Email:*

Mailing Address:*

Best Contact Number*

Phone

Project Details

Name of the Project:

Course Launch Date:

Please note: Please allow 6-8 weeks ahead of launch for reviews and quiz implementation.

Suggested Course End Date:

If your course will offer Continuing Education (CE) credit, the course should end at least two weeks prior to the end of the calendar year.

Need/Gap Analysis driving the project:

Learning Objectives:

Is this project funded?*

Yes

To be determined

What outcomes do you intend to measure?*

Research Details

Do you intend to publish results from this QuizTime activity?*

Yes

Please let us know of any IRB submissions or approvals in regard to this quiz request?*

Who will be the contact person for the research/quality improvement activities related to this project?*

Email Address:*

Will you require screenshots of your QuizTime course components?*

Screenshots may be required for your project of various course components including the catalog view, pre or post-course announcements, or questions. You will identify the necessary screenshots on the course parameters form that will need to be completed closer to course launch.

Yes

Learner Population Details

Learner Population Description:*

Approximate number of learners in the population:*

Continuing Education Credit Details

Will your project offer CE credit?*

Yes

Please check the types of CE credit you would like the course to offer:*

Please note the following:

If you choose CNE, CPE, or CRNA, there is a separate approval process that will need to take place.
NPA credit will be automatically offered if CME credit is selected. If a learner falls into the NPA category, a certificate will be available once credit is claimed and can be taken back to their accrediting body for equivalent credit (this is at the discretion of the accrediting body).

Continuing Medical Education (CME) - Physicians

Non-Physician Attendance (NPA)

Continuing Nursing Education (CNE)

Continuing Pharmacy Education (CPE)

Certified Registered Nurse Anesthetist (CRNA)

Doctor of Dentistry (DMD)

Doctor of Dental Surgery- Orthodontist (DDS)

Communication Details

How will your quiz be communicated to your learner population?*

Please provide any detail on communication you may have available at this time. There will be an opportunity for a deeper dive into your communication plan. This may include direct emails to leadership, a post in a newsletter, etc.

Follow Up and Next Steps

Thank you for completing the intake form. The next step will be to schedule a meeting with the CAMHL team to review the intake form and discuss next steps.

Availability:*

Please provide three specific dates and times, as well as any other individuals who should be included in the initial meeting from your team. Please include their email addresses.

Send me a copy of my responses

Privacy Notice|Report Abuse