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2012
November
T
THR Leadership University Customer Request Form
THR Leadership University Customer Request Form
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Hello:
Thank you for utilizing the Center for Learning to help support your needs. Please fill out the following form to enable us to identify some of your major concerns.
Thank you very much for your time and support. Please begin by clicking on the
Continue
button below.
*
First Name
:
*
Last Name
:
*
Phone
:
*
Email Address
:
In what THR facility are you currently employed?
-- Select --
I am not a THR Employee
Texas Health Arlington Memorial Hospital
Texas Health Harris Methodist Azle
Texas Health Harris Methodist Hospital Cleburne
Texas Health Harris Methodist Hospital Fort Worth
Texas Health Harris Methodist Foundation
Texas Health Harris Methodist Hospital Hurst-Euless-Bedford
Texas Health Harris Methodist Hospital Southwest
Texas Health Harris Methodist Hospital Stephenville
Texas Health Presbyterian Foundation
Texas Health Presbyterian Allen
Texas Health Presbyterian Dallas
Texas Health Presbyterian Denton
Texas Health Presbyterian Kaufman
Texas Health Presbyterian Plano
Texas Health Research & Education Institute
Texas Health Resources
Texas Health Springwood Allen
Texas Health Springwood Arlington
Texas Health Specialty Hospital Fort Worth
Texas Health Springwood Southlake
Texas Health Physicians Group
Texas Health Organization for Physicians
Texas Health Med Synergies
What prompted this request? What is the presenting problem?
What are the desired outcomes you want to achieve? In other words, in a perfect scenario what would success look like?
Who will be the audience? (Please choose from the best solution below)
-- Select --
Individual
Dyad - Leader & Direct Report
Work Group - Leader & Group of Peers
Work Group - Group of Peers Only
What have you tried so far to address the situation/challenge?
When would you like to begin?
Do you see any barriers to accomplish the desired outcome?
What will success look like?
How many people will be impacted?
What will be the impact to your department/business unit if change/improvement does not occur?
Overall comments:
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