The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit North American phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

tT2cHJrWumffMgXqsASN2SDqfQ4vAe4675msrgCZNpSAPJKYNAEEXk5GNy3aresaXv5gF4Acg692UzXbYkKGHaZF

TREE Hosting Intake Request

Thank you for considering the ITHS Translational Research Education Engine (TREE). Learning Management System (LMS).

Please take a few minutes to complete all the below intake questions. This information will help to expedite your request and inform the conversation our educational specialists will have with you during the initial intake meeting.

**PLEASE NOTE: All fields are required except for the additional documentation section at the end**

If you have any questions related to this intake form, please reach out to ithsedu@uw.edu.

Name

Are you a part of an ITHS Core?

* must provide value

Yes

reset

Select the ITHS Core

* must provide value

Are you an employee UW, FH, or SCCA?

* must provide value

Yes

reset

Are you employed through an institution within the WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region?

* must provide value

Yes

reset

New or Existing

* must provide value

New

Existing

reset

What type of course are you wanting to host in the TREE?

Course Title:
Course Description:


Learning Objectives:



Do you have additional learning objectives for this course?


What options would you like included in your course?


Desired Start Date for the course:				Desired end Date for the course:

Enter the organization code the course is listed under in the TREE:					What is the TREE course code:
Enter the Course Summary Link
What changes would you like assistance in makeing?

Describe the target course audience:

Is this a required training for your target audience?					Will there be a fee for learners to take this course?

Please provide any additional documentation or notes that you believe will be helpful for our educational specialists to know to facilitate setting up your course (ex: proprietary information or licensing requirement around the information contained in your course).
	or

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.