HLA 2027 Application

Full Name

First NameLast Name

I am a

If Other Health Professional - what kind?

If Other Administrative Professional - what kind?

My Preferred E-mail Address is

example@example.com

My Secondary E-mail is

example@example.com

Cell Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

My job title is

My department is

I primarily work for

Other

Current Home Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Do not exceed 200 words per question

Why do you want to join HLA 2027?

0/200

What, in your mind, would constitute success for this course?

0/200

What is the biggest leadership challenge you currently face?

0/200

Briefly summarize your prior and current healthcare leadership or administrative roles and responsibilities.

0/200

What kind of leadership roles are you interested in for your career?

0/200

Upload your bio as a PDF, including a photo. Name the file (in all caps) LASTNAME_FIRSTNAME_BIO.PDF. The bio should not exceed one 8½ × 11-inch page.

Upload a manager or department head recommendation confirming departmental or organizational approval of financial support, titled LASTNAME_FIRSTNAME_REC.PDF

Upload LASTNAME_FIRSTNAME_REC.PDF.

You may add an extra letter of recommendation as LASTNAME_FIRSTNAME_ADDREC.PDF if desired.

Upload LASTNAME_FIRSTNAME_ADDREC.PDF.

I certify that my sponsor or supervisor supports my participation in HLA 2027; that I will personally cover the estimated $500 cost of required reading materials/books; that my department/organization will cover the $5,500 tuition (unless a scholarship request to Dr. Chris Kane is approved); and that I am able to attend at least nine of the ten complete monthly sessions, as outlined below, and plan to attend the Capstone/Graduation:

HLA1 — Jan 7 (PM), Jan 8 (all day), Jan 9 (AM)
HLA2 — Feb 5 (PM) — Feb 6 (AM)
HLA3 — Mar 5 (PM) — Mar 6 (AM)
HLA4 — Apr 9 (PM) — Apr 10 (AM)
HLA5 — May 13 (PM), May 14 (all day), May 15 (AM)
HLA6 — Jun 25 (PM) — Jun 26 (AM)
HLA7 — Jul 30 (PM) — Jul 31 (AM)
HLA8 — Sep 16 (PM), Sep 17 (all day), Sep 18 (AM)
HLA9 — Oct 22 (PM) — Oct 23 (AM)
HLA10 — Nov 19 (PM) — Nov 20 (AM)
Capstone/Graduation — Dec 4 (AM)

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UCSD Health Leadership Academy 2027 Application

Application Questions