HPO Exploration Lab Application
Organization name:
*
Organization address:
*
Organization phone number:
*
Participant(s) Information: (Please fill out information for all participating staff from your organization. Content boxes for each employee are separated by a dividing line.)
Name:
Title:
Phone:
Email:
Name:
Title:
Phone:
Email:
Name:
Title:
Phone:
Email:
Name:
Title:
Phone:
Email:
Name:
Title:
Phone:
Email:
Name:
Title:
Phone:
Email:
Brief description of your organization (number of employees, annual operating budget, services provided, etc.):
*
Describe how your management team functions (administrative duties, leadership responsibilities, etc.):
*
What does your team want to gain from this exercise?:
*
