Nomination: Leadership Fundamentals Program

The Leadership Fundamentals is a 12-week cohort program designed to build and sustain effective leadership habits and confidence levels of new medical leaders.

Type: Blended (in-person and Zoom class sessions)
Duration: 21 hours over 12 weeks (10 hours in class)

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* 1. Who would you like to nominate to this program?

First Name

Last Name

Email address

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* 2. What is your nominee's leadership role?

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* 3. What is your nominee's department?

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* 4. What is your nominee's practice type?

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* 5. Which community of care does your nominee primarily work in?

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* 6. Why do you wish to nominate this individual?

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* 7. Please provide the following information about yourself as a nominator:

First Name

Last Name

Email address