QI Project Proposal Form

Thank you very much for your interest in proposing a project to the Ohio AAP. Please reference this document for information on what is covered by the Ohio AAP’s PIP Committee.

If you would prefer to download the form be filled out at a later date (either electronically or printed), click here.

Name and Credentials *

Email *

Organization/Practice Name

Team Members (if applicable)

Project Title *

Budget Estimate

Has funding been secured?

No

Yes - Please indicate source, amount and timelineYes - Please indicate source, amount and timeline

Proposed Timeline for Project:

Community Partners

If applicable, please include what they are providing.

What are we trying to accomplish?

Proposed Aim Statement – How good? For whom? By when? 1-2 sentences

Problem to be addressed

Defines WHAT broadly; 2-3 sentences

Rationale for addressing the problem.

Defines WHY; please include what has been done in this area already; include citations, if applicable; 5-7 sentences

Anticipated goals or outcomes

Defines WHAT specifically and how long you think it will take to reach your goals; still not HOW; 3-4 sentences

What are your ideas for achieving your anticipated goals or outcomes?

Explain HOW you will reach your goals

Barriers to success

Expand on what might inhibit project’s success

If you are human, leave this field blank.