X
GO

Leadership Fellows Program Application Form

Deadline for Submission: Nov. 28, 2016

Program Cost Disclaimer:

Due to the interest in the program, the application process is highly competitive. Please take that into consideration when submitting your application.

This program requires a registration fee of $1,295 per attendee for the 2017 year upon acceptance into the program. This fee covers all programming, materials and meals occurring during programming time. This fee does not include hotel or travel costs or registration fees for the THA Annual Conference and Expo. A limited number of scholarships through the THA Foundation will be available.


Biographical Information:

*
*
*
*
*
*
*
*
*
*
*
*










*



*





*



*

Supplemental Application Pieces:

(Please include a current copy of your resume or CV. Accepted formats: Word doc or PDF.)

(Please include a one-page letter of interest or essay describing why you feel you would be a good candidate for the Texas Hospital Assocation Leadership Fellows Program. Accepted formats: Word doc or PDF.)


Recommenders:

As part of the application, you are required to submit two letters of recommendation.* The recommenders must be individuals who have supervised your work and/or have assessed your performance during your career and can attest to your ability to bring value to the THA Leadership Fellows cohort.

Step 1: The applicant must contact each recommender and ask him or her to provide a letter to support your application to the THA Leadership Fellows Program. Give your recommenders plenty of time — THA must receive the letters by the application deadline date of Nov. 18, 2016. If both letters are not received by the deadline, your application cannot be considered. The applicant is responsible for following up with his or her recommenders to ensure the letters are received by the application deadline.

Step 2: The recommendation letters can be emailed or mailed in by the recommender or the applicant to the address listed on the application checklist. Please remember, the applicant is responsible for contacting and following up with his or her recommenders to ensure THA receives the letters by the application deadline.

* Important note: One recommendation must be from the candidate's current direct supervisor and must acknowledge endorsement of the time commitment required to attend the program. It is up to the candidate to communicate this requirement to his or her supervisor.

Please provide the names of your recommenders below.

Recommender #1

*
*
*

Recommender #2

*
*
*

Goals:

Please take a moment to provide short 1-2 sentence answers to the following questions concerning your expectations of the Leadership Fellows Program.

A major component of this program is a class-driven project requiring individual and group participation.


Required Acknowledgement of Attendance Requirements:

One of the main benefits of this program is the knowledge and idea-sharing that will accompany each module. Therefore, attendance by all fellows at every module is of utmost importance.

By checking this box, if accepted into the program, you are agreeing to attend all required modules, including the THA 2018 Annual Conference and Expo, and are acknowledging the importance of regular attendance.

Please note: Attendees who do not complete each required module will not be able to participate in the recognition ceremony at the THA 2018 Annual Conference, nor will they be granted their certification of completion.


I acknowledge that committing to attend each required module is of utmost importance and attendance at each module is required in order to receive my certificate and graduate as a THA fellow.

*


Program Cost Disclaimer:

This program requires a registration fee of $1,295 per attendee for the 2017 year upon acceptance into the program. This fee covers all programming, materials and meals occurring during programming time. This fee does not include hotel or travel costs or registration fees for the THA Annual Conference and Expo. A limited number of scholarships through the THA Foundation will be available.

Due to the interest in the program and limited number of spots available, the application process is highly competitive. Please take that into consideration when submitting your application.