ACR Learning Network ImPower Application

ACR Learning Network ImPower Application

Dear Applicant,

Congratulations on taking the first step towards joining the Learning Network!

If you are not yet familiar with ImPower and the Learning Network, please watch our introductory video prior to completing this application.

If you have any questions while filling out the application, you can reach out to us for help.

Thank you!

The ACR Learning Network Team

Please provide information about your organization and primary contact.

Organization Information

An organization consists of one or more facilities who are aligned clinically, operationally, and financially and are working together towards a common purpose. Ex: Health system, National radiology practice, Independent Radiology Practice, etc.

Organization Name*

Organization Website URL

Has your organization previously participated in an ImPower cohort?*

Select or enter value

Primary Contact Information

The primary contact is the person completing the application and the primary point of contact during the interview process.

Contact Name*

Contact Role at Organization*

Contact Email Address*

Contact Phone Number*

Phone

Please provide information for the collaborative you would like to join.

For which collaborative are you applying?*

Please note: if you wish to apply to multiple collaboratives or bring multiple projects to the General Improvement Group, please complete one application per collaborative or per project. Thank you!

Select or enter value

By participating in ImPower, what would success look like for your organization?*

Send me a copy of my responses

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