AHRA and Canon Medical Putting Patients First Grant Application

AHRA and Canon Medical Putting Patients First Grant Application
Participant Information
Full Name*

First NameLast Name
AHRA Member Number (ID)*
Found in your AHRA profile via https://account.ahra.org
Email Address*
example@example.com
Phone Number
Please enter a valid phone number.
Program Overview
AHRA's Putting Patients First Program, through the generous support of Canon Medical, seeks to improve patient care and safety in general medical imaging through an innovative grant-making program. The Putting Patients First Program will provide five grants of up to $10,000 each to fund programs, training or seminars aimed at improving patient care and safety which can then be used to create best practices that can be shared and implemented at other hospitals and institutions.
Which type of program is your organization hoping to implement with this grant?*

Diagnostic Imaging (up to $10,000)Pediatric Imaging (up to $10,000)Oncology Imaging (up to $10,000)Medical Physics (up to $10,000)Radiation Safety (up to $10,000)
Please describe your organization's plan for creating and implementing a program to improve patient care and safety in medical imaging. Describe the shape of the program will take (traditional program, staff training, seminar, etc.), its main objectives/goals, timing, and anticipated outcome(s).*
Describe how your program will be implemented across your hospital system/imaging center, including the plan to ensure quality, consistency, and compliance.*
Describe how the best practices and lessons learned from the program can be shared across your hospital system/imaging center.*
Please provide a title for this program*
Please provide a project timeline for this program. *
Please provide a preliminary budget for this program (or provide attachment of budget below)*
Timeline & Budget Documentation Upload

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Please include documentation that shows support for the program. Your support could include, but is not limited to, a letter or marketing brief announcing the program to staff/partners, planned speaking engagements or sharing best practices with colleagues to promote your facility's commitment to improving patient care and safety.*

Please upload a PDF file to protect formatting.
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Optional: Please add additional information for the selection committee to consider
I certify this application contains no misrepresentations or falsifications and this information is true and correct to the best of my knowledge. I understand that any false statements made herein will void this application and I will be ineligble for support from the AHRA & Canon Medical's Putting Patients First Program. I have read the eligibility requirements and certify that I and my facility are eligible for this grant. I also certify that I understand and agree to the funding overview, judging, timing and program criteria as stated in this application.
Participant Signature*

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Signature Date*

MonthDayYear
Date
Participant's Name*

First NameLast Name
Participant's Title*
Director, CEO, CFO, etc.
Participant's Organization Name*
Please do not abbreviate organization's name.
Please download this PDF Form and have the Senior Manager fill it out. Please upload the filled and signed PDF below.
Senior Manager Form

PDF only
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Senior Manager's Name

First NameLast Name
Senior Manager's Title
Director, CEO, CFO, etc.
Senior Manager's Organization Name
Please do not abbreviate organization's name.
Should be Empty:

AHRA and Canon Medical Putting Patients First Grant Application

Participant Information

Program Overview