Quality Improvement Initiative Form

Please fill out the form and hit the submit button at the bottom.

Timeline:

Planned Start Date:

Planned Completion Date:

 

Answer the following questions:

A. Give this Quality Improvement Initiative a short Description:

B. Describe the goal of this initiative in 100 words or fewer:

C. Identify the Single AQIP Category which you feel this initiative will impact most:

D. 1. Describe the process(es)/event /services/etc. that you feel this initiative will improve and 2. Explain how this initiative might follow/promote the concepts of Lean Higher Education:

E. List the organizational areas – institutional departments, programs, divisions, or units – most affected by or involved in this initiative:

F. Describe how you plan to monitor the net improvement created by this initiative:

G. Describe the Overall "outcome" measures or indicators that will tell you whether this initiative has been a success in achieving its goals

H. Who will be the chief contact person for this initiative?:

I. Is there a budget for this initiative?:
YES NO

Where will the funding come from?

 

(Please list costs appropriately):

Labor Costs:

Materials Costs:

Postage Costs:

Travel Costs:

Other Costs:

TOTAL COST:

 

Signature:

Submitted by:

Initials:

Date: