FPE Faculty Proposal

General Information

Be sure to include "PURCH-specific" or "LEAD-specific" information, attach required materials, and name required documentation when appropriate.

FPE Course Title (and number, if known) *

Has this FPE been offered previously? *

UMass Chan FPE Faculty Sponsor and Supervisor *

I am a member of the UMass Chan Faculty

Sponsor email (must be umassmed.edu, umassmemorial.org, or baystatehealth.org)) *

Preferred Contact Email (can be any domain)

Sponsor phone *

Sponsor mailing address

Sponsor Department *

Additional Evaluating Supervisor(s) and Support Personnel

Evaluating Supervisor (type "Sponsor" if same person) *

FCE Support Personnel *

Additional Evaluating Supervisor

FPE Information and Description

This experience is PURCH track specific This experience is LEAD@Lahey track specific

Experience Location (include contact information and room numbers) *

Day One Instruction (report time & where, where to park, advance reading, etc.) *

Interdisciplinary | list other disciplines or specialties

Interprofessional | list other professionals

UMass Chan Milestones | all that apply *

Longitudinal Focus Topics | select all that apply Societal Forces in Health and Disease Health Systems Science Health Equity, Diversity, and Inclusion

Experience Description (you may upload further information below) *

Experience Objectives (eg, By the end of this session student will be able to...) *

Evaluation

Evaluation Type | all that apply *

Optional | upload further FCE information (eg, syllabus, readings, etc.)

Additional Comments or Proposal Information

August 3 2023 | cjb

Faculty Proposal Submission Form | Explorations 24-25

General Information

Additional Evaluating Supervisor(s) and Support Personnel

FPE Information and Description

Evaluation