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Practice Council Agenda Item Request Form

UCLA Health - Practice Council

New Submission - Practice Council Meeting Agenda Item

ALL REQUESTS MUST BE SUBMITTED AT LEAST TWO WEEKS PRIOR TO THE PRACTICE COUNCIL MEETING.

Please complete this form to request inclusion on the Practice Council Meeting Agenda. Practice Council meets on the third Thursday of each month (times may vary).

*Complete one new form for each agenda item request.

Important: You will be notified of your assigned presentation time. Please be available to present from 8:30 am - 9:30 am on the day of the meeting.

This question requires a valid date format of MM/DD/YYYY.
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2. Your Name, Credentials, and Email Address: *This question is required.
3. Your Facility: *This question is required.
7. What outcome(s) are you expecting from the Practice Council as a result of your presentation? Select all that apply. *This question is required.
9. Please upload your PowerPoint presentation and handouts. If you are requesting a review of changes to an existing document, please either submit the document using track changes or provide both clean and edited versions of the document. You may upload multiple files using this button.