Clinic Leadership Institute
New Executive Leadership Transitions (nEXt)

Program Application

Thank you for your interest in Clinic Leadership Institute’s (CLI) New Executive Leadership Transitions Program (nEXt). The nEXt program, a signature project of Blue Shield of California Foundation and supported by the California Community Foundation, is part of the CLI suite of programs that focus on new and existing leaders in California community health centers to develop the skills needed to drive organizational and system transformation. Please review the following program requirements before completing the application.

We recommend completing the application in Microsoft Word before entering all information online. Applications must be submitted online; this Word document is for your reference only.

Application Deadline:Applications and all supporting documents must be submitted via online application on or before5:00pmFriday, March 10, 2017.

Eligibility

Applicants must meet the following criteria to be eligible for the program:

  • Serve as the Chief Executive Officer/Executive Director at an eligible community health center.
  • Have been in current role of CEO/Executive Director for less than 18 months.

Important Dates

Meeting 1 / April 13, 2017, 10:00 am to 8:00 pm (full day session including dinner with Cohort 5)
Meeting 2 / July 12, 2017, full day
Meeting 3 / September 15, 2017, full day
Meeting 4 / November 8, 2017, full day

* Locations alternate between Bay Area and Southern California.

Participants are expected to attend all four sessions. For questions about the application, please contact Amy Quan at .

Clinic Leadership Institute

New Executive Leadership Transitions (nEXt)

Program Application

Section 1: Participant Demographic Information

First name:

Last name:
Gender: Male Female
Do you consider yourself to be of Hispanic, Latino or Spanish origin? Yes No
Which of these categories best describe your race? (Choose all that apply)
American Indian or Alaska Native
Asian/Pacific Islander
Black or African American
White
Other, please describe
Position title:

Name of clinic organization

Location of corporate office (city, state):

Counties served:

Telephone number: Email address:

Length of time in current CEO position (months):
Length of time at current organization (years):

Length of time as a previous member of the same clinic’smanagement or executive team (years):

Section 2: Questions

  1. Why are you interested in participating in the CLI nEXt program?

(750 word limit)

Section 3: Attachments

Please attach the following required documents to the online application where indicated.

Attachments:

Current Resume/CV

Section 4: Submit Application

Please submit your online application by 5:00pm on March 10, 2017.

For application questions, please contact Amy Quan at .

Thank you for your interest in the Clinic Leadership Institute New Executive Leadership Transitions Program! We look forward to reviewing your application.

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