Leadership Fellows Application - Texas Hospital Association

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No one likes it when a form has an error and all your hard work is lost. Be sure to save your work before submitting the form below just in case.

Questions:
If you experience any issues with the form, please contact the THA Service Center at servicecenter@tha.org or 512/465-1057.

Applications are now closed for the 2023 class.

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.

Biographical Information:

Name(Required)

First Last

Degrees(Required)

Designations(Required)

Title(Required)

Company/Organization Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Fax

Email(Required)

Enter Email Confirm Email

Current Position by General Role(Required)

Please Specify

Hospital Ownership(Required)

Investor-Owned

Public/Government-Owned

Not-for-profit

Partnership

Hospital Type(Required)

Urban

Rural

Suburban

Critical Access

Academic Medical Center

Hospital Size(Required)

Under 100 Beds

101-500 Beds

500+ Beds

Please select your gender identity:(Required)

Female

Male

Transgender

Genderqueer/gender non-conforming

Other

Age:(Required)

26 or under

27-40 years old

41-57 years old

58-76 years old

75+ years

Race and Ethnicity*:(Required)

(*Options determined based on proposed U.S. Census categories). May select multiple categories .

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or Pacific Islander

White

Other

Supplemental Application Pieces:

Please send via email to afugate@tha.org your Resume and a Letter of Interest, which is one-page letter of interest or essay describing why you feel you would be a good candidate for the Texas Hospital Association Leadership Fellows Program.

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. 25, 2022. 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 (email to Angela Fugate, afugate@tha.org) or mailed (Texas Hospital Association Attn: Angela Fugate, 1108 Lavaca Street, Ste. 700, Austin, TX 78701) 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

Name(Required)

First Last

Title(Required)

Organization(Required)

Recommender #2

Name(Required)

First Last

Title(Required)

Organization(Required)

Goals:

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

The main reason I am interested in the THA Leadership Fellows Program is:

I expect the THA Leadership Fellows Program to provide me with:

The main topics I would like to see addressed in the program are:

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

Do you have any potential project ideas or problems that need solved at your facility?:

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 2024 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 2024 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 $1,995 per attendee for the 2023 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.

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.

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