Corman IMPACT Honors Form - The Schwartz Center

Please complete the form below to submit your initiative or program for the 2024 Corman IMPACT Honors. Your organization must be a Schwartz Center healthcare member in good standing to be considered.

We strongly suggest that you save your responses in a Word or Google document in case there are technical issues during the submission process.

Please note that programs or initiatives developed elsewhere and implemented within a member organization (e.g. Code Lavender, Daisy Award, etc.) are not eligible. Schwartz Rounds^® and Stress First Aid programs do not qualify.

Deadline for submission: March 29, 2024.

You will receive a confirmation email after submitting your materials. If you have questions, please contact Angelina McCoy, member experience manager at amccoy@theschwartzcenter.org

Name(Required)
First Last Suffix

Schwartz Center Member Organization
Please begin typing your organization name to search.

Organization Name
If you don't see your site listed above, please enter it below. If you're not sure if your site is a Schwartz Center healthcare member, please contact membership@theschwartzcenter.org before completing the rest of this form.

Job Title(Required)

Phone(Required)

Email(Required)
Enter Email Confirm Email

Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Program Information

Program or initiative name(Required)

Please provide a description of the program, including who the program serves.(Required)
Please note that Schwartz Center programs, including Schwartz Rounds and Stress First Aid, are not eligible. We strongly suggest that you save your responses for these questions in a Word or Google doc in case there are technical issues during the submission process.

How does your program address the three areas of impact of healing, vision and equity?(Required)
The areas of impact can be found here.

What gaps did you identify that inspired the need for this program within your organization, system or community?(Required)

How has this program made an impact in your organization, system, or community?(Required)

How have you or how do you plan to measure the impact of this program?(Required)

Have you been able to scale this program, or do you have plans to? (e.g., started in one unit now in more units; started in one hospital now in other system hospitals.)(Required)

Additional Information or Letters of Support

(It is optional but encouraged to submit up to five additional supporting materials (i.e., letters from program participants or beneficiaries, articles about the program, outcome reports, etc.). PDFs are preferred.

File
Max. file size: 512 MB.

Consent(Required)
I understand that all program information and materials submitted may be shared via the Schwartz Center websites, newsletters, social media, collateral and at Schwartz Center events. Appropriate credit will be given to each member organization.

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Corman IMPACT Honors 2024

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