Request for Residency Learning Network Coach Question Title * 1. Your name Question Title * 2. Your residency program Question Title * 3. Your email address Question Title * 4. What type of coaching do you need for your current or future residency learning network? Pick your top three only. I need coaching on: defining a governance structure creating goals and objectives developing strategies for communication with network members identifying and securing funding collecting and storing data creating agendas for network meetings securing funding determining who should be part of the network setting expectations for participants determining how to get staff support Other (please specify) Question Title * 5. Specific to your coaching request, what's your involvement with this residency learning network? This is a new network I'm interested in starting. This is an existing network that I'm interested in enhancing. Other (please specify) Question Title * 6. Note any other comments or requests Question Title * 7. I agree to participate in an evaluation of the effectiveness of the coaching. Yes No Submit