Submitting an Online Application for the 2018 Quality Improvement & Health Outcomes Award

Applications for the 2018 Quality Improvement & Health Outcomes Award will be accepted until November 17, 2017.

Please read the following section on Documents You'll Need so that you can complete these items and have them ready on your computer before you begin filling out the application.

Documents You'll Need to Include with Your Submission

The following documents need to be submitted with your application. Please complete them before beginning your submission making note of where on your computer you've placed them as the application form will ask you to browse and selected these files.

  • Applicant's Curriculum Vitae: Your curriculum vitae;
  • Facility Administrator's Sponsorship Letter: The sponsorship letter from the facility administrator where project will be conducted must be signed by the facility medical director if the applicant is not a medical director. The letter should affirm the facility’s commitment to the project, his/her willingness to support your involvement in this project, and his/her agreement to disperse funds in accordance with the award guidelines outlined in the program brochure. If the applicant is not a medical director, please have the facility’s medical director also sign the facility administrator letter.
  • AMDA Member Sponsorship Letter: A sponsorship letter from an AMDA member sponsoring the application is necessary if the applicant is not an AMDA member. The letter should address the sponsor's level of involvement in the project.
  • Foundation QI Awards Project Proposal: This document includes the objectives, research design, methodology, and expected performance outcomes of your proposal. A ready made form, which you can fill out and submit with your application can be downloaded from the following link:

    Foundation QIHO Awards Project Proposal

  • Foundation QI Awards Detailed Budget: This document addresses justification for expenses, including materials, travel to AMDA-The Society for Post-Acute and Long-Term Care 2017, AMDA's annual meeting ($1,500), and in-kind support from the facility (if any). A ready made form, which you can fill out and submit with your application can be downloaded from the following link:

    Foundation QIHO Awards Detailed Budget

The above documents should be one of the following types: MS Word (doc or docx); PDF (pdf); MS Excel (xls or xlsx); MS Powerpoint (ppt or pptx); Text (txt); and ZIP (zip). The maximum file size for any document submitted with your application must not exceed 6,144 KB in size (6 megabytes).

Please contact us if you need any assistance with creating and uploading your documents.

Internet Explorer Users:

We recommended that you submit our forms using a modern compliant browser such as an up-to-date version of Chrome, Firefox, or Safari and avoid using MS Internet Explorer, especially older versions, which present some compatibility problems.

2018 QI & Health Outcome Award - Online Application Form

Applicant's Information

Page 1 of 3

The information on this page pertains to the applicant's information.

First Name(*)
Please provide your full name.

Last Name(*)
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Credentials(*)
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Please list credentials separated by commas.

Title / Position(*)
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Institution / Facility
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Facility Tax Id(*)
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State / Federal Survey(*)
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Please upload a current copy of the State/Federal Survey results for the institution/facility in one of the following file formats: doc, .docx, pdf, txt.

Address(*)
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City(*)
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State(*)
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Zip(*)
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Phone(*)
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E-mail(*)
Invalid email address.

Attendance(*)
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I understand that a facility representative must be in attendance at an upcoming AMDA-Society for Post-Acute and Long-Term Care Medicine annual convention to receive the award and present their program at a session.

 

Project Information

Page 2 of 3

The information on this page pertains to the project you're proposing.

Project Title(*)
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Medical Director(*)
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Enter the name of the Medical Director for the Institution/Facility.

AMDA Member(*)
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Is the medical director for the institution/facility an AMDA member?

Letter of Support(*)
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Please upload the Letter of Support from the facility’s medical director where the project was conducted in one of the following file formats: doc, .docx, pdf, txt.

QI Project Proposal(*)
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Please upload the completed AMDA Foundation/QI and Health Outcome Awards Project Proposal form in one of the following file formats: doc, .docx, pdf, txt.

QI Detailed Budget(*)
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Please upload the completed AMDA Foundation/QI and Health Outcome Awards Project Proposal form in one of the following file formats: doc, .docx, pdf, txt.

Total Expenses(*)
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Please enter the total expenses for the project proposal.

 

Validation Check

Page 3 of 3

The information on this page pertains to the security and validation of your submission.

Captcha(*)
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Type the four lower case characters shown in the box above on the left into the box on the right and click Submit. You may click the Refresh link above as many times as you need to until you're confident you see the letters clearly.