Principal contact *
Email *
IPE Lead Faculty *
Event Date(s) *
Event Title *
Purpose of Event/Activity *
Description of Activity: *
Anticipated # of students needed *
1) Are there at least 2 professions participating in the event? This is a requirement for IPE events. *
- Select - Yes No
Other
3) Is there involvement of other faculty/students from other programs in the planning of the activity/event, to ensure relevance and accessibility to all students (timing, location, outcomes)? *
- Select - Yes No
4) List names and email addresses of activity/event planners: *
5) If volunteers are needed, please create a digital group sign-up sheet, Be sure to list the description and quantity needed of each volunteer role. Students from different disciplines are working together working to learn about, from, and with each other. List the sign-up document’s link here: *
a) How will the above competencies be assessed? *
Please email ipe@ulm.edu to access IPE assessment tools currently in use at ULM.
8) How will your IPE activity/event prepare the students for collaborative practice? *
9) Target Audience and maximum number of participants: *
11) Timeline of Activity: *
12) Pre-Event Assignment (if any):
13) Do you need assistance from the IPE Co-College Committee? If so, please let us know how we can help below.
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