Global Health Program Advisory Service Needs Assessment

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* 1. Name:

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* 2. Title:

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* 3. Institutional Affiliation:

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* 4. Email:

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* 5. Telephone Number:

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* 6. Do you envision participating in this program as a...

Advisee

Mentor

Both

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* 7. Please provide the following information about your current global health educational program:

Program or track name:

Program website (if available):

Year of program initiation:

Department or school responsible for the program:

Current number of participating faculty (or enter "unsure/unknown"):

Current number of participating trainees/students (or enter "unsure/unknown"):

Discipline(s) in the program:

Level(s) of trainees involved in the program:

Please provide a brief description of your program and tell us what you consider to be its defining characteristics:

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* 8. Which of the following problems or concerns would you like to address as part of this advisory service? (Please indicate ALL that apply)

Program funding

Curriculum and/or teaching methods

Increasing program size

Development of new program features

Developing or strengthening overseas partnerships

Increasing and/or improving faculty involvement

Developing or improving field experiences

Increasing level of university support

Other (please specify below)

Other problems or concerns you would like to address:

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* 9. For advisees, please provide a brief description of the most important issues you wish to address in the coming year. (Include up to 3 areas you wish to work on and indicate in descending order the most to least important.)

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* 10. For advisees, if you are to use the CUGH advisory service, please describe what 'success' will look like for you.

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* 11. For mentors, please indicate which of the following areas you feel most comfortable in providing assistance. (Please indicate all that apply.)

Program funding

Curriculum and/or teaching methods;

Increasing program size;

Development of new program features

Developing or strengthening overseas partnerships

Increasing and/or improving faculty involvement

Developing or improving field experiences

Increasing level of university support

Other (please specify below)

Other areas you feel most comfortable providing assistance:

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* 12. For mentors, if you participate in the CUGH advisory service, what would a successful mentor-advisee relationship look like to you?

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* 13. For mentors, the minimum expected commitment includes regular telephone communication (preferable a monthly call), a site visit and a final report of recommendations. Do you feel you are able to provide this level of commitment?

Yes