2018 Leadership in Healthcare Program Application

Thank you for your interest in the Leadership in Healthcare Program. Please complete the following application, and have a department chairman, program director, or other mentor complete the online Nomination Form.

Completed Nomination Form should be submitted directly to CNS from the individual providing the recommendation. All application materials, including the nomination form, are due to the CNS by 5:00 pm CT on January 15, 2018.

Please note: It is the responsibility of the applicant to work with his or her colleagues to coordinate the recommendation. The applicant must send this online Nomination Form to his or her colleague to complete the form.

YOUR INFORMATION
Please provide the following information about you.
Files must be less than 2 MB.
Allowed file types: pdf doc docx.
Files must be less than 2 MB.
Allowed file types: pdf doc docx.
Personal Statement describing leadership goals and relevant leadership experience (Maximum 200 words)