Work Force Event Requests

Work Force Event Requests

Thank you for your interest in partnering with Western Reserve Hospital.

Please fill out the form below to propose your collaboration with us. Upon submission, a representative from Western Reserve Hospital will reach out to you to schedule a meeting to discuss the partnership further.

We look forward to exploring potential opportunities for collaboration with your organization.

All requests must be submitted 30 days before your requested start event date. If they are received within 30 days of requested date there is no guarantee that your experience can be fulfilled.

Contact: Gia Polichena, MBA

Manager, Education and Development

gpolichena@westernreservehospital.org

330-971-7061

Organization Information

Please complete all required fields with accurate information. Do not enter "NA" in required fields.

Organization*

Organization Contact First and Last Name*

Phone Number*

Email*

Please enter a valid email address where you can receive communication regarding event and scheduling.

Work Force Event Information

Please complete all required fields with accurate information. Do not enter "NA" in required fields.

Title of Event *

Event Type Request*

Select or enter value

Request Event Date*

Event Location*

Where would you like this event to be hosted? At Western Reserve Hospital or at your organization?

Purpose of Event *

Target Audience

Audience *

Description of the target audience for the event (e.g., healthcare professionals, community members, patients, students, etc.)

Estimated Number of Attendees *

Logistics

Resources and Support Requested*

Specific resources or support required from Western Reserve Hospital (e.g., venue, equipment, staff assistance, promotional materials, catering, etc.)

Select or enter value

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