Kelowna General Hospital Medical Staff Retreat Application Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.General InfoDate *Project Title *Proposed Time Frame (Date of Retreat) *Total Amount Requested *Submitting Department *Name of Applicant(s) *Project LeadName *Phone Number *E-mail Address *Other Applicant InfoApplication Completed By *Project DetailsSummarise the issues and relevant background (i.e. the issue, how it has evolved, current situation, how you intend to resolve the issue) *Identify all areas impacted by this issue and retreat *Describe the Objective of the project, the desired outcome and how funds will be used; and who will benefit from the outcome. *Describe how the retreat aligns with KGH MSA’s mission & vision, as well as the strategic goals of the hospital and IH. *Are there any environmental factors, regulatory/ethical requirements or legal ramifications to consider? *Please identify any other projects that may be affected by this initiative. *Describe any assumptions or constraints that have been identified (any factors that are assumed to be true and remain true during this project or anything that will restrict the successful outcome of this project). *Please indicate how you will assess the outcome of this retreat. Please advise us if you require assistance to evaluate the outcome of this project *Meeting CostsNumber of physicians involved *Number of hours per physician *Total sessional fees at $176.18 / physician *Total meals at $40 / physician *Project lead costs (hours worked) *Total amountSystem calculates all sub-totals aligns Name environmental Total AmountName of the applicant *Signature Clear Signature Submit
