Apply for Leadership Health Fellows Online Use the form below to apply to become one of our leaders Step 1 of 4 25% Leadership Louisiana Health FellowsName(Required) First Middle Initial Last Email(Required) Cell PhonePreffered Name for Name Badge(Required)Home Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Years lived in LouisianaAgeGenderEthnic BackgroundHow did you hear about the program? Business InformationCompany / Organization / Agency Name(Required)Current TitleOffice Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business PhonePlease check the category(s) which best describes the area in which you presently work / serve.(Required) Non-Profit Self-Employeed Education News/Media Cooporation Government Elected Officials Professional Clergy Culture/Arts Health Care Business Owner Other You selected Other. Please tell us more: Applicant QuestionsDescribe your most meaningful leadership or service contribution during your career. How has this experience shaped your perspective on community well-being, health, or quality of life?(Required)What do you hope to gain from the Leadership Louisiana Health Fellows experience, and how will you apply that knowledge to improve health outcomes, systems, or access in Louisiana?(Required)In your opinion, what is the most significant health-related challenge facing Louisiana over the next five years, and why?(Required)Is there a personal or professional experience that has shaped your interest in health or health care?(Required) Required AttachmentsBrief resume or bio that includes the following:(Required) Education & Training—College, Specialized Training, Dates Attended, Certificates or Degrees Employment—Present Employer (title, date began, brief description of responsibilities), Brief History Elective Offices, Awards, Honors, Recognitions Drop files here or Select files Max. file size: 50 MB. A letter of recommendation:may be mailed/emailed directly to Better LA (sheree@betterla.org). Note: The Leadership LA nomination form is not considered a letter of recommendation. Drop files here or Select files Max. file size: 50 MB. Professional Headshot(Required) Drop files here or Select files Max. file size: 50 MB. Application Fee(Required) Price: Credit Card Commitment I understand the purpose of Leadership Louisiana Health Fellows and if selected, will devote the necessary time to complete the program. I realize that if I cannot fulfill the attendance requirement listed on this application, I will not be able to graduate from the program and remaining tuition will be forfeited. I have the cooperation of my employer (unless self-employed, CEO or business owner), whose signature below verifies his/her understanding of my attendance requirements.SignatureDate MM slash DD slash YYYY This website uses cookies to ensure you get the best experience. Learn more Got it!
