Faculty of Health Sciences

Department of Health Management & Policy

Healthcare Leadership Academy | May 26 - June 4, 2016

Deadline for submitting applications: May 20, 2016

Institution Group Registration Form

* The Institution Group Registration Form should be filled and sent via email to: along with the CVs of the participants.

Institution information
  • Name of the Sponsoring Institution: ______
  • Institution Type:

International Organization or UN Agency

Governmental Institution

University or Research Institution

Non-Governmental Organization

Private Sector

Other: ______

  • Address: ______
  • Phone Number: ______
  • How did you hear about HLA:

Mailing List

AUB Website

Colleagues

Other: ______

Please select the corresponding number of the module of your choice for each participant in the table

Module 1: Fundraising Strategies in Healthcare Marketing (May 26 - May 28, 2016)

Module 2: Patient Safety and Risk Management (May 30 - June 1, 2016)

Module 3: Patient-centered Care and Patient Experience (June 2 - June 4, 2016)

Participants information
Full Name
(Name, Middle Name, Surname) / Title / Gender / Phone Number / Email / Highest Education Degree / Position / Choice of Modules
1 / Prof
Dr.
Mrs.
Mr.
Other / M
F / Module 1
Module 2
Module 3
2 / Prof
Dr.
Mrs.
Mr.
Other / M
F / Module 1
Module 2
Module 3
3 / Prof
Dr.
Mrs.
Mr.
Other / M
F / Module 1
Module 2
Module 3
4 / Prof
Dr.
Mrs.
Mr.
Other / M
F / Module 1
Module 2
Module 3
5 / Prof
Dr.
Mrs.
Mr.
Other / M
F / Module 1
Module 2
Module 3
6 / Prof
Dr.
Mrs.
Mr.
Other / M
F / Module 1
Module 2
Module 3
Full Name
(Name, Middle Name, Surname) / Title / Gender / Phone Number / Email / Highest Education Degree / Position / Choice of Modules
7 / Prof
Dr.
Mrs.
Mr.
Other / M
F / Module 1
Module 2
Module 3
8 / Prof
Dr.
Mrs.
Mr.
Other / M
F / Module 1
Module 2
Module 3
9 / Prof
Dr.
Mrs.
Mr.
Other / M
F / Module 1
Module 2
Module 3
10 / Prof
Dr.
Mrs.
Mr.
Other / M
F / Module 1
Module 2
Module 3
  • The attachment of the Curriculum Vitae (CV) of each participant is mandatory for the completeness of the Institution Group Registration Form and the prompt process of the application.

Payment information
  • Cost: $400 per module. A 20% discount will be offered for institutions registering participants in 5 or more modules.

Deadline for submitting institution group application: May 20, 2016
Deadline for payment: payment must be made in full by May 20, 2016

  • Payment can be settled through the following channels: Direct Pay at AUB Cashier, Bank Transfer or interdepartmental transfer for AUB/AUBMC employees.
  • An invoice will be sent to the institution upon approval of the group registration along with the payment instructions.

Terms of Agreement

Cancellation Policy

Terms of Agreement

All notification of withdrawals, transfers and substitutions must be sent in writing to the Health Management and Policy Department, FHS, AUB. The deadline for cancellation of registration in a module is May 20, 2016. Due to the costs incurred for program preparation and administration, any cancellations or requests for transfers or deferrals received after May 20, 2016 are subject to 100% penalty fee and hence no refund.

Substitutions: All participant substitutions are subject to the sole discretion of the Health Management and Policy Department, FHS, AUB. Requests must be submitted in advance and will be reviewed on an individual basis, based on participant qualifications and lead-time needed for any program pre-work.

Transfers: Transfer requests must indicate the new dates and/or new modules the participant wishes to attend.

*The Health Management and Policy Department, FHS, AUB is not responsible for travel or related costs under any circumstances. Participants may want to consider purchasing trip cancellation insurance in the unlikely event that a program is cancelled or they cannot attend for personal or professional reasons.

Photo Release

I hereby grant the AUB Faculty of Health Sciences permission to use the likeness of the participants in photograph(s) in any and all of its publications and in any and all other media, whether now known or hereafter existing, controlled by AUB, in perpetuity, and for other use by the University. I will make no monetary or other claim against AUB Faculty of Health Sciences for the use of the interview and/or the photograph(s).

By submitting this application, the applicant understands and agrees with the Health Management & Policy Department, FHS, AUB cancellation policy. Applications cannot be processed without this agreement.

I Agree to Terms of Agreement

Contact information

Dr. Mohamad Alameddine

Chairperson, Department of Health Management and Policy, FHS, AUB
Tel: +961 1 350000 ext. 4693 / Fax: +961 1 744470

Mrs. Gina Cordahi

HLA Coordinator, Department of Health Management and Policy

Email:

Tel: +961 1 350000 ext. 4639 / Fax: +961 1 744470

OR

Visit HLA webpage: http://www.aub.edu.lb/fhs/hla