Nominator Form

Thank you for taking the time to nominate a colleague for the 2019 – 2020 HBA NE Region Executive Exchange program. 
 
Before completing this nominator form, please ensure that the candidate meets the following Executive Exchange participant criteria:
  • Female or male leader in a healthcare or life science company (not a service provider)
  • Currently holds a C-suite, SVP, or VP role; if VP role then must have 1+ year experience
  • Has significant responsibility for strategic/ operational decisions, direct reports and budget accountability
  • Is committed to:
    • Their own career advancement
    • Helping advance other women’s careers
    • Attending 7 monthly events between November 2019 and May 2020 including the mandatory kick-off event scheduled for November 6, 2019 (location TBD); Please ensure nominee’s understanding of, and commitment to, this requirement
 About the Executive Exchange Nominations:
  • Nomination submissions are being accepted now through August 23, 2019.
  • Nominees will be notified of their program status on or before  September 13, 2019.
  • Nominees accepted into the program will not exceed one per company per roundtable.
Sources of nominations include: HBA corporate partners, HBA NE company sponsors, HBA NE regional council / volunteers, and self-nominations.

Nomination Submissions (consisting of both the Nominator and Nominee Forms) are recorded by date and time of completion which could become relevant should there be more qualified nominees than there are roundtable placements.

The Executive Exchange committee’s goal is to create optimal roundtable groupings based on nomination submissions for candidates who satisfy all participant criteria.

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* 1. Your Contact Information
(Areas with asterisks [*] are required)

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* 2. Nominee Contact Information
(Areas with asterisks [*] are required)

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* 3. About the Nominee

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* 4. Please ensure the nominee understands the commitment this program requires.  Is the nominee committed to preparing for, attending and participating in monthly events, including:
  • 2 large group events: November Kick off event and May year-end event
  • 5 roundtable meetings: December through April

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* 5. Is your company interested in exploring sponsorship opportunities for Executive Exchange?  If yes, whom in your organization should HBA NE connect with?

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