Skip survey header

Course Code & Training Request Form

If you have questions while completing this form, please contact Paula DeBates, or 573-884-8061.

This form offers two educational training request options:  
  • Option 1:  Request a course code for the following activities or similar events: in-service, department meeting, competency fair, hospital-wide meeting, journal club
  • Option 2: Request the design and development of educational materials. 
    • Educational material examples:  web-based module, case study, simulation, webinar, learning video, instructor-led training, job aid, training publication materials
If you selected Option 1, the CED team will review your request, supply a course code, or request additional information within 5 working days. 

If you selected Option 2, your request will be sent to CED Leadership team for review before moving forward. Upon approval, a CED representative will conduct an educational needs analysis to develop the appropriate learning tools.   
NOTE:  Please do not use all capaltization text when completing this form.  
1. Requester information *This question is required.
5. Is this training mandatory and approved by leadership?  *This question is required.
7. To the best of your ability, please provide all Facilities, Departments,  HRDEPTID's, and Title Codes for the intended target audience (all who will be assigned to complete or attend this training). 

 If the training is considered hospital-wide, enter the title codes that will be excluded (if any) from completing the required training.  Please separate each entry with a comma when entering more than one HRDEPTID or Title Code. 
NOTE:  CED Tech Team will be in contact to further develop the training assignment process for Saba. 
1-2 sentence description to be displayed in Saba
Objective example:  Upon completion of this training,  the learner will be able to demonstrate proper hand washing techniques.  
  (Typically 1-3 objectives are listed.)
15. Select the appropriate training option *This question is required.
OPTION 2 – Request the design and development of educational materials
Please complete option 2 questions to the best of your ability. 
19. Is this a new educational training request?
20. If this is a revision, what type?