2021-2022 NOA Leadership Institute Application

The Nebraska Optometric Association’s Leadership Institute was created to identify, educate, inspire, and empower a community of leaders to become engaged advocates for the profession. The Leadership Institute provides recently-licensed optometrists (licensed for 10 years or less) in Nebraska the opportunity to enhance their abilities to be successful practitioners and leaders in the profession and in their community.

Application deadline is July 15, 2021.

All nominees will be notified regardless of acceptance in early August.

The form below is to directly apply for the 2021-2022 NOA Leadership Institute. If you would like to nominate a colleague for the Leadership Institute, you can click here to do so before June 18.

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* Contact Information:

Name:

Practice name & city:

Year you were Licensed

Mailing address:

City:

State:

Zip:

Email address:

Cell phone:

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* List the professional, civic, political or social organizations or activities you have been involved with. Please include any relevant comments or descriptions of your involvement in these, including any leadership roles.

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* What do you consider your most significant contributions to date related to your profession or practice (could include activities during optometry school as well as since graduation)?

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* What do you consider your most significant contributions or accomplishments outside of your profession (community involvement, etc)?

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* What do you hope to accomplish in your optometric career?

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* What do you see as the biggest concerns for your profession?

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* What do you hope to gain from participating in the NOA Leadership Institute?

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* By typing your name below and submitting this application, you agree that if you are selected, you will pay the necessary tuition, commit the time to attend each class, and complete required volunteer assignments.