Application Form for the Executive Healthcare Leadership Institute Executive Healthcare Leadership Institute Application Form – 2023 Please select one:(Required) Self nomination Nomination for someone else Applicant Name(Required) First Last Credentials Email(Required) Rank(Required) College(Required)Please click and select from below menuAcademic AffairsCollege of Health ProfessionsCollege of MedicineCollege of NursingCollege of PharmacyCollege of Public HealthDepartment(Required) Department Chair's Name(Required) Department Chair's Email Address(Required) Please upload an updated copy of your CV(Required)Max. file size: 7 MB.5 Questions Document Upload(Required)Accepted file types: pdf, Max. file size: 7 MB.Please upload a PDF with the following questions answered: 1. What are your 5-year career goals? 2. How will participating in this program help you achieve these goals? 3. What is your personal philosophy or definition of leadership and how does it apply to your professional role? 4. How are you fostering diversity, equity, and inclusion at UAMS or in your field? 5. Please describe any leadership training you have had.Have you had previous leadership training?(Required) Yes No UAMS Training Investment Recovery PolicyBelow you will need to download a copy of the UAMS Training Investment Recovery Policy, fill out the last two pages and upload the agreement. ONLY THE FACULTY MEMBER APPLYING FOR THE EXECUTIVE HEALTHCARE LEADERSHIP PROGRAM NEEDS TO SIGN THE AGREEMENT. THE COST OF THE LEADERSHIP TRAINING PROGRAM IS $10,000 PER ATTENDEE FOR THE SESSIONS.UAMS Training Investment Recovery Policy 4.4.24 Agreement(Required)Max. file size: 7 MB. UAMS-Training-Investment-Recovery-Policy-2021Download
