Professional Development & Quality Leadership Grant Application

Professional Development & Quality Leadership Grant

Application Form
Grant Amount: Up to $1,000 (Total)
Payment Structure:
- Up to $500 awarded upfront upon application approval as reimbursement for professional development costs.
- Up to $500 awarded upon successful completion of the QI project and all presentation requirements.
Purpose of the Grant
The Ohio Association for Healthcare Quality (OAHQ) is committed to fostering the next generation of quality leaders and advancing healthcare excellence in Ohio. The Professional Development & Quality Leadership (PDQL) Grant provides up to $500 upfront to an active OAHQ member with at least one year of healthcare quality experience to pursue a professional development opportunity (such as a certification, conference, or workshop).

This grant links learning with action. The funding supports an applicant who will use the knowledge gained to complete a quality improvement (QI) project. An additional maximum of $500 is awarded upon completion of the project and its successful presentation to the OAHQ membership as a one-hour educational webinar, suitable for CPHQ® continuing education (CE) credit.

Name*

First NameLast Name
Postnominals*
(e.g., BSN, RN)
Email*
example@example.com
Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Years of Healthcare Quality Experience*
Job Title*
Organization*
Upload your CV or Resume

Acceptable file types: PDF, .DOC, .DOCX, RTF
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Describe the conference, certification, or educational program you wish to attend.
Name of Activity/Event:*
(e.g., IHI Forum, NAHQ® Next Conference, CPHQ® Exam)
Sponsoring Organization*
(e.g., NCQA)
Activity Start Date

MonthDayYear
Date
Activity End Date

MonthDayYear
Date
Location*
Activity/Event Address

Street Address

Street Address Line 2

CityState

Zip Code
Primary Learning Objectives*
(List 2-3 key skills or knowledge areas you expect to gain.)
Total Cost of Activity (USD)*
(Note: The maximum total grant is $1,000.)

Please provide an itemized breakdown of how the $1,000 in grant funds will be used. Funds may be used for registration fees, travel, lodging, materials, or exam fees. *
(e.g., Conference Ticket - $499; Hotel - $305)

Describe the QI project you will lead, which will be supported by your professional development and will serve as the basis for your 1-hour CE webinar.
Project Title*
Problem Statement*
(What problem are you trying to solve? Why is it important? Include baseline data if available.)
Project Aim Statement (SMART Goal):*
(What do you aim to achieve? Be Specific, Measurable, Achievable, Relevant, and Time-bound.)
Proposed Intervention(s):*
(What is your initial plan or main idea for improvement?)
How will the Professional Development (Section 2) support this project?*
(This is a critical link.)
CPHQ Content Outline Alignment - Briefly describe how your project and future presentation will align with one or more domains of the NAHQ® CPHQ® exam content outline, such as Quality Leadership, Performance Improvement, or Health Data Analytics:*

Please provide an estimated timeline for your professional development and QI project. The final presentation must be completed within 18 months of receiving the initial funds.

Project Timeline and Reporting*

Rows	Estimated Completion Date
Attend Professional Development Activity
Finalize Project Charter & Stakeholders
Implement Interventions / Begin PDSA Cycles
Project Completion & Final Data Analysis
Develop 1-hour Webinar Presentation
Deliver OAHQ 1-Hour CPHQ® CE Webinar

By signing below, I certify that the information provided in this application is true and accurate. Additionally, I understand and agree to the following terms:
1. Grant applications are accepting from active OAHQ members on a rolling basis. All grant awards are subject to approval by the OAHQ Board and funds availability. Grant applications may be declined for any reason at any time. Only one grant per OAHQ member is permitted. Grants may not be made to current OAHQ Board members or officers.
2. This grant is awarded in two installments: up to $500 upfront as reimbursement for the professional development activity, and up to $500 upon completion of the final project presentation.
3. Upon OAHQ Board approval of the application, I agree to submit a receipt for the initial reimbursement within 30 days.
4. I agree to complete the proposed quality improvement project (or a substantially similar project, as approved in writing by the OAHQ Board) within 18 months of receiving the initial grant reimbursement.
5. I agree that to receive the final $500 payment, I must present the findings, methodology, and outcomes of my QI project as a 1-hour live (and recorded) webinar for members of OAHQ and partner state associations in the Healthcare Quality Collective.
6. I understand this webinar must be of high quality, suitable for earning CPHQ® continuing education (CE) credit, and must align with the NAHQ® CPHQ® exam content outline as described in my application.
7. Upon application approval, I agree to share a professional photograph/headshot with the OAHQ Board and permit the publication of the photo and my name on the OAHQ web site, newsletter, and other marketing materials.
8. I will coordinate with the OAHQ Board to schedule the webinar and a prior-day dry run, and will provide all necessary materials (current CV/resume, short biography, forms, abstract, learning objectives, CPHQ® content outline alignment, slides) for the CE application process.
Disclaimer: CPHQ® and NAHQ® are registered trademarks of the National Association for Healthcare Quality (NAHQ®). No ownership or control of CPHQ® or NAHQ® is intended or implied by using the trademarks in this document. NAHQ® is the approver-body for OAHQ continuing education for CPHQ® credit.
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