SCMEC Leadership Program

Application Form

Description

This is 2 to 3-month project for individuals who are members of SCMEC and want to gain and utilize their skills to become more involved in the organization in a leadership role.

This leadership opportunity will encompass 30% mentoring and coaching and 70% application of learning through the project completion. Individuals admitted to this program will have a mentor from the SCMEC board who will commit to meet with the individual throughout the program and help apply information into the needs and goals of SCMEC.

Each individual, in collaboration with their mentor, will identify a leadership project they will work on during the term. We have identified 4 growth areas for the organization and the projects should be created around these:

  • Membership
  • Social Networking
  • Education
  • Legislation

Objectives:

At the end of the programs, individuals will do presentations at a SCMEC Quarterly meeting on their project, focusing on:

1) Description of the project

2) What was accomplished

3) Next steps for the project, if any, and the timeline for completion

Why Participate?

  1. Assist in your own professional development
  2. Give back to the CME community
  3. Be more involved with SCMEC without the commitment of having a board position
  4. Use the experience to meet CHCP and other credentialing requirements
  5. Document your potential for promotion to your supervisor
  6. Contribute to fulfilling new ACCME Accreditation with Commendation criteria C34

Application Process

Interested parties must complete required application which includes an approval/acknowledgment from your supervisor. Applications should be submitted via email to by April 21, 2017. Final acceptance will be announced in early to mid May once applications have been reviewed. Acceptance notices will be sent via email to you and your supervisor.

Name

TitleInstitution

Office Address

Office Phone Email

Currently enrolled in an academic/certificate program? (Y/N)

If yes, what field/area?

Have you had formal leadership training outside? (Y/N)

Have you attended any professional development or supervisory/leadership classes at within your organization? (Y/N)

If “yes” to either question above, please list the classes you have attended:

  1. Why do you want to participate in the SCMEC Leadership Program? (250 word limit)
  1. What can you contribute to SCMEC Leadership Program? (250 word limit)
  1. What is one of your personal/professional goals for the coming year? (250 word limit)
  1. Which growth area are you interested in? (check one)

☐Membership

☐ Social Networking

☐ Education

☐ Legislation

Supervisory Acknowledgment Form

Leadership ProgramApplication for (Applicant Name/Organization):

Please sign/type name below acknowledging you are aware of applicant’s interest in the program and your approval for them to participate, should they be selected.:

Supervisor Name/TitleDepartment/Organization E-mail

The completed Application with Supervisory Acknowledgment Form should be sent by April 21, 2017 tofor consideration.