<p> Women and Newborn Health Service E-learning Proposal Submission Form</p><p>This submission form enables the WHNS e-learning education sub-group to monitor e- learning resource development across WHNS to ensure: </p><p> there is no duplicated effort across the state with program development.  program development can be effectively prioritised.  support may be available to those developing e-learning resources following consultation with the e-learning education sub-group.  all e-learning programs published on the Education Hub undergo a quality peer review/ endorsement process to ensure WNHS e-learning principles, WA Health communication style guidelines and web guidelines are met.</p><p>Email completed form to the Education Technology Coordinator – [email protected]</p><p>Is this a new resource? ☐ OR an update to an existing resource? ☐</p><p>If this is an update to an existing resource who is the original owner of the resource?</p><p>Has permission in writing been received to permit the use/modification of the resource? ☐Yes ☐No</p><p>Please provide a brief statement to support the development of this resource:</p><p>How will this resource be made available to the target audience?</p><p>☐Internet ☐Intranet ☐Both </p><p>(It is recommended that all e-learning resources were possible be available on the internet via the WNHS Education hub) Please provide the following information for your proposed resource:</p><p>Title:</p><p>Learning outcomes:</p><p>Modules/Topics:</p><p>Format/software/Media/photos/interactiv e elements:</p><p>Assessment:</p><p>Evaluation:</p><p>Reporting:</p><p>1. Details of Resource lead (sponsor)</p><p>Name: Position: Department: Contact Ph: Contact email: 2. Details of the person developing the content for the e-learning resource</p><p>Name: Position: Department: Contact Ph: Contact email: </p><p>3. Details of the person developing the resource in the e-learning software.</p><p>Inhouse:</p><p>Name/Company: Position: Department: Contact Ph: Contact email: </p><p>Outside contract: </p><p>Company: Contact Name: Contact Ph: Contact email: </p><p>4. How often will staff be required to complete this e-learning resource? (Please provide any supporting documentation e.g. policy statement/ NHSQS reference) ☐Annually ☐Once only ☐Other - please specify: </p><p>5. How long will it take participants to complete the resource?</p><p>6. Are there any policy statements/ NHSQS references etc. to support the frequency/ priority of this training? ☐Yes ☐No</p><p>Details: 7. Has a search been undertaken to determine if a similar resource is already available? ☐Yes ☐No</p><p>8. If similar resources are available please provide evidence supporting the development of this additional resource:</p><p>9. Who is the target audience?</p><p>☐All WHNS staff</p><p>Or specific only to: ☐Managers ☐Medical ☐Nursing ☐Midwifery ☐Support Services ☐Admin staff ☐Maintenance ☐Allied Health ☐Corporate</p><p>10.Has any funding been secured to develop this resource? Funding source: Amount: Anticipated closure date of project (program to be published online): </p><p>11.Name and contact details of your review team members (the program lead may be a review team member). Please note the review team members need to represent the target audience.</p><p>Name: Position: Health Service Area: Contact Details: Name: Position: Health Service Area: Contact Details: </p><p>Name: Position: Health Service Area: Contact Details: </p>