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Leadership Application Form

"*" indicates required fields

Please provide a brief biography about yourself. Optional: Include a link to your LinkedIn profile.
Please upload your resume.
Max. file size: 10 MB.
Please upload a personal statement on your qualifications and expectations and goals for participation: Consider including a description of your professional experience and areas of interest that would be well served by this program. Identify past and current leadership roles and how you see your future opportunities as a leader in healthcare and in the service of patients and the medical profession.
Max. file size: 3 MB.
Please provide a statement of purpose that include:
  • Examples of previous leadership activities and their outcomes. (Physicians early in their career are encouraged to describe their vision of leadership in the current environment.)
  • Understanding of time commitment required to complete this program.
  • Explanation of how this program may impact your current work and life situation.
  • Statement demonstrating a commitment to health policy leadership on behalf of practicing physicians.
This program will require flexibility from your current position to fully attend two 5-day residencies (plus travel days as needed) in the Boston area in September 2025 and 2026 and monthly one day instructional online sessions; applicants must be in attendance during all sessions. You are also required to commit to completing all your coursework outside of class time as directed. Please describe your current position and how you will be able to accommodate this requirement, including any support you have already secured from your organization.
September 2025 Availability*
I attest that I am available to be in Boston Friday, September 26 – Wednesday, October 1, 2025.
September 2026 Availability*
I attest that I will be available to be in Boston for 5 days in September 2026. *We will share the specific dates as soon as they're confirmed. We are cognizant of religious and national holidays and will plan accordingly
Homework Completion*
I attest to agreeing to complete all required homework outside of class in advance of each monthly class.
Please upload a professional letter of reference.
Max. file size: 3 MB.
Please upload a second professional letter of reference.
Max. file size: 3 MB.
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