2018 Leadership in Healthcare Program Nomination Form

Recommendation forms must be submitted by 5:00 pm CT on January 15, 2018.

The Leadership in Healthcare Application review will take place within the CNS Executive Committee and/or designated subcommittees. Applicants will be notified of their status in early March.

YOUR INFORMATION
Please provide the following information about you.
Leadership in Healthcare Program Participant Information
Please rate the candidate’s ability to perform the following actions/behaviors based on the following rating scale:
1 = very unlikely to perform the action/behavior, 2 = unlikely to perform the action/behavior, 3 = neutral, 4 = likely to perform the action/behavior, 5 = very likely to perform the action/behavior
How likely is this candidate to: