Community Health Center University (CHCU) Leadership Program Application
Developing the next generation of Virginia's health center leaders.
Application deadline: October 15, 2025. Applicants will be selected by October 31, 2025.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Name of Health Center
Health Center Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Position/Title
Length of Service in Current Position (Years, Months)
Supervisor Name/Title
Supervisor Email
example@example.com
Supervisor Phone
Please enter a valid phone number.
Which of the following best describes your employer? (Select one)
Community Health Center
Free Clinic
Other
Emergency Contact Name and Relationship
EDUCATION BACKGROUND: School Name, Location, Years Attended, Area of Study, Degree Received
Would you require overnight accommodation for in-person sessions at the University of Richmond?
Yes
No
RESUME & REFERENCES: Upload a current copy of your professional resume and provide three (3) references that can speak to your current or potential leadership skills (ex: current/former supervisor, colleague, former teacher, friend).
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Please upload a letter of support from your current supervisor, signed by them and your CEO
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Have you held a leadership role before within your organization? If yes, provide the length of time and describe your role and responsibilities. If no, describe what role you would like to have in leadership and why. (Limit 500 words)
Please describe your leadership style. If you are unsure, describe the type of leader you want to be. (Limit 500 words)
What is your ideal of a good leader? (Limit 500 words)
As an emerging leader, how do you address equity and inclusion within your current position? (Limit 500 words)
How do you see yourself working toward health equity in your current role? And if you move into a leadership role, how does this work change, if at all? (Limit 500 words)
What areas of leadership are you most curious to gain more experience in and why? (Limit 500 words)
What skills are you looking to gain by participating in this leadership course? (Limit 500 words)
Why should you be selected to participate in this leadership program? If selected, how do you plan to utilize the skills gained in the leadership program in your current and future positions? (Limit 700 words)
What would you say is the biggest leadership challenge within your organization? How can you help to meet that challenge? (Limit 500 words)
Please describe two opportunities for growth that this leadership program can help you to improve. (Limit 500 words)
What contributions have you made to your community in your current position? (Limit 300 words)
List contributions you have made towards improving the operations, culture, and/or employee engagement within your current position. (Limit 300 words)
Describe one significant professional accomplishment you have made in the past three (3) years and what skills you used to meet the challenge. (Limit 500 words)
By submitting this application I acknowledge the time commitment and effort that it will take to complete this program:
I understand that I must attend all 10 coaching sessions
I understand that I must attend all classroom sessions
Please type your full name as an electronic signature
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