Ucsf School of Medicine

http://leadershipdevelopment.ucsf.edu/

APPLICATION

UCSF SCHOOL OF MEDICINE

LEADERSHIP DEVELOPMENT PROGRAM

Class of 2016-2017

Deadline for Receipt of Applications: August 26, 2016

To submit your application (two methods):

1) Send pdf of application via email marked “Confidential” to: (Stephanie Belger)

2) Send paper application via inter-office mail to: The School of Medicine Leadership Development Program Selection Committee, Box 0410

PART I: APPLICANT INFORMATION

Name:______

Department:______

Campus Phone: ______Box #: email:

Payroll Title: ______

Date of hire into your current position:

Total Years of UC Service:

Supervisor’s Name:

Supervisor’s Phone: Box #: email:

APPLICANT’S SIGNATURE

I understand that participation in this program requires a commitment averaging 5 hours per month during regularly scheduled work hours, and that attendance at all program events is mandatory.

______

SignatureDate

1. Why are you applying to the Leadership Development Program and what would you like to gain/learn from your participation?

1. What do you think are the most important characteristics a person must possess to become a successful leader? Provide detailed examples of where you displayed some of these characteristics.

1. Who has been the most influential person or what has been the most important event that has occurred to help shape your own leadership development?

1. Describe why your experience and education make you an appropriate candidate for this program.

1. Describe the actions you have taken to enhance your career or improve your management/professional skills within and outside of UCSF. Please include formal education, training, community service, and professional associations.

1. Give an example of a decision you made at work that you now consider to have been a mistake, and describe how you would handle it differently today?

1. Provide an example of a time when you have benefited your work group or department through the use of your leadership abilities.

PART III: Letters of Reference

As part of your application, you must obtain two letters of reference in support of your application. These letters should come from individuals who can talk about your work experience and achievements. It is encouraged, but not required, that one letter of reference come from your supervisor.

Those individuals serving as references must send their letters directly to the Leadership Development Program Selection Committee.

To the Reference:

Thank you for agreeing to write on behalf of this candidate, who is applying for the School of Medicine Leadership Development Program. To assist the Selection Committee in evaluating this candidate’s application, please address the following in your letter:

 Define your relationship to the candidate (e.g., supervisor, coworker, mentor).

 Describe what distinguishes this candidate in terms of management/leadership abilities and potential, and provide specific examples of the employee’s work and/or leadership experience which demonstrate these characteristics.

 To your knowledge, what has the candidate done to further her/his development, either through formal professional development programs or in other ways? Please explain how the candidate interacted with you in seeking personal or professional development. Where applicable, please describe the most constructive piece of feedback you have given the candidate and how the candidate responded?

• Please describe the candidate’s strongest leadership skill.
• What would you describe as the candidate’s most significant area for improvement, and why?

When you have finished writing the letter, please sign and date it and then send this reference letter to the Selection Committee in one of two ways:

1) Please email a pdf of the signed and dated reference to Stephanie.belger@.ucsf.edu (Stephanie Belger).

2) Please place it in interoffice mail in an envelope marked “confidential” and send it to: The School of Medicine Leadership Development Program Selection Committee, Campus Box 0410 or 513 Parnassus Avenue, Suite 224, San Francisco, CA 94143.

Important: Reference statements will not be shared with the candidates. Thank you again for serving as a reference for your candidate.

PART IV: SUPERVISOR’S SIGNATURE

Have your supervisor review the time commitment and indicate his/her support of your application by signing the below statement.

Return the signed statement with your application.

SUPERVISOR’S SIGNATURE

Participation in the Leadership Development Program will require a commitment averaging 5 hours per month during regularly scheduled work hours and attendance at program events is mandatory. Your signature acknowledges your understanding of these requirements and your support of ’s application.

______

SignatureDate