Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Organization Name *About the person filling the formFull Name *Email *WhatsApp Number *About the projectName of Project ECHO *The Name should include the word “ECHO”Project Purpose *Provide a concise description of the clinical or educational gap this program aims to bridge.Core Learning Objectives *What are the main things learners will gain?Target Audience *Define the specific healthcare workers or participants (the “Spokes”) who will benefit.Start Date *Date of the first sessionEnd Date *Date of the last sessionTime (Sudan Time) *Frequency / Day of Week *Eg. Bi-weekly, Monthly on Sturdays, Sundays?Number of Sessions *Curriculum Outline *List the specific topics for each of the proposed sessionsProgram Director Name *Facilitator Name *Coordinator Name *IT Support *Learning Site (you can choose more than one) *Dr. Bushra Ibnauf Center – Port SudanDr. Bushra Ibnauf Center – GedarifOthersIdentify the physical locations or hubs where the program will be hosted or focused.If others, specify *Endorsements *List any partner organizations, Ministry of Health departments, or local institutions supporting this projectSubmit
