AMWA ELEVATE APPLICATION

In submitting an application to participate in AMWA ELEVATE, you commit to a 6-month (April - September 2023) virtually conducted leadership program.

The AMWA ELEVATE Certificate in Leadership Fundamentals-1 focuses on six core leadership competencies.

To participate, you agree to the following time commitment monthly:

15-40 minutes to view an assigned prerecorded video or article
1.5 hours of virtual, small-group coaching (exploration and active learning)
1 hour Mastermind session
1 individual professional coaching session
Submit reflection questions as part of a final project that invites you to explore your growth as a leader
Option to earn up to 18 coaching-focused, reflective-CME credits

Participants who fulfill the required elements will receive a Certificate of Leadership Fundamentals-I from AMWA.

Course Dates

Saturdays @ 10 am ET April 15, May 13, June 17, July 29, Aug 26, Sept 30
Tuesdays at 11 am or 6:30 pm ET April 11, May 9, June 13 July 25, Aug 22, Sept 26

Program Fee

AMWA members: $3400*; non-members: $4500 [Retail value: $10850]
*If you are not eligible for institutional support and this cost is prohibitive, you may apply for an AMWA Leadership Diversity Grant

Name*

First NameLast Name

Credentials*

Title/Position(s)*

Are you an active AMWA member?*

YesNo, but I plan to joinNot yet, I would like to learn moreNot interested at this time

Employer/Institution*

Specialty*

Years in Practice*

Birthplace (City, State)*

State/City of Current Residency*

Please tell us why you want to participate in this program? How do you know you are ready?*

How do you contribute diversity to this program cohort? (i.e. race, ethnicity, religion, background, gender or sexual orientation, disability, etc.)*

Share 3 adjectives to describe yourself *

What does leadership mean to you?*

How will you contribute to the long-term success of this program?*

Are there any other factors that you consider important to your personal profile that you wish us to consider in assessing your participation.*

Course Date Preference: Select the option(s) that fit your schedule*

Tuesday morningsTuesday eveningsSaturday morningsThese times don't work for me but I am still interested

Email*

example@example.com

Mobile Number*

Please enter a valid phone number.

Attach Current CV*

Date of Submission*

Date

How did you learn about AMWA ELEVATE?*

Do you plan to apply for a Leadership Diversity grant?*

YesNo

Certificate of Leadership Fundamentals-1 for Women Physicians