Triological Society Leadership Academy Application
Name
*
First Name
Last Name
Suffix
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Institution Name
*
1. Leadership Experience and Scope
Describe leadership roles that you have had in the past or currently hold. Include the scope of responsibility, team composition, and measurable outcomes where applicable.
*
2. Leadership Challenge and Response
Describe a significant leadership challenge you have experiencedor witnessed. What was the approach, what stakeholders were involved, and what was the outcome? If the outcome was not what was envisioned, how would you have approached next steps?
*
3. Vision for Impact
What leadership impact do you hope to have in Otolaryngology-Head and Neck Surgery over the next 5–10 years?Be specific about the domains you aim to influence (education, research,advocacy, health equity, administration, innovation, etc.). Within the house ofOtolaryngology – Head and Neck Surgery, share with us your visions for applyingnewly acquired knowledge on a local, regional or national level.
*
4. Self-Assessment and Growth Areas
From your perspective, what qualities and/or strengths do you have that will enhance your leadership skills? What specific competencies do you hope to acquire through this course? (Examples: financial literacy, negotiation, executive presence, team development, change management, strategic planning.)
*
5. Diversity of Perspective and Team Leadership
How have you fostered inclusion, mentorship, orprofessional development within your teams or department? Provide specific examples.
*
6. Time Commitment and Engagement
The course requires active participation, preparation,and project engagement. Confirm your ability to commit the necessary time anddescribe how you will ensure full participation.
*
Please include any social media handles you use.
File Upload - Applicant CV
Browse Files
Drag and drop files here
Choose a file
Document should be uploaded in .pdf format
Cancel
of
File Upload - Letter of Recommendation 1
Browse Files
Drag and drop files here
Choose a file
Document should be uploaded in .pdf format
Cancel
of
File Upload - Letter of Recommendation 2
Browse Files
Drag and drop files here
Choose a file
Document should be uploaded in .pdf format
Cancel
of
Submit
Should be Empty: