Vernissage Health - Early Career Health Leaders (ECHL) Registration Survey

Welcome to ECHL - We want to learn more about you!

Thank you for taking the time to complete this registration survey. This survey will take approximately 15-20 minutes of your time. The primary objective of the survey to assist the Project Faculty understand your current leadership focus, learning needs and leadership goals. This will indicate whether this program is the right offering for you at this stage of your career.

Based on information submitted in this application, applicants will be short listed for an interview with Project Faculty to determine eligibility for participation. In addition, if you receive an offer of participation in the program, your survey answers will assist the Project Faculty assign or “match” you with an established leader/mentor for 1:1 leadership coaching.

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* 1. Contact Information:

Name

Email Address

Phone Number

Title

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* 2. Please indicate the year you received or will receive your most degree from a graduate program in health care. If you have not received a graduate degree, please proceed to Question #4.

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* 3. For the purposes of Vernissage Health, health leadership roles are broadly defined. Please indicate your current leadership role/title? Select the role that most closely aligns with your present position.

Physician Chief/Medical Director

Division or Program Chief

Team Lead

Mid-Management

Senior Management

Academia/Scientist Leader (University-based)

Scientist Leader (Hospital/agency-based)

Project Lead

Other (please specify)

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* 4. Please indicate the program you are enrolled in or the degree you received.

MBA

MHSc

PhD

MSc

MPH

Other (please specify)

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* 5. Please indicate the type of organization in which you are currently employed:

Academia (University-based)

Acute care hospital

Public health service/agency

Rehabilitation hospital

Home care agency

Long-term care facility

Community care organization (Community Health Centre or other)

Family health team/primary care

Federal/Provincial Government

Social services agency

Consulting

Independent business/self-employed

Private sector, health

Private sector other

Other (please specify)

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* 6. Please indicate your career stage in health leadership:

Early-career (1-5 years of health leadership experience)

Mid-career (6-10 years of health leadership experience)

Late-career (10+ years of health leadership experience)

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* 7. There is an enrolment fee for this program which will be discussed during the application process. Please indicate below if you would like to discuss financial accommodation for this program based on current student debt or other financial considerations.

Yes

Uncertain

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* 8. Tell us about yourself as a leader. Please include some of your current beliefs, goals, frustrations, or aspirations for health leadership. Please briefly describe your current leadership role and what leadership challenges you face in your current role.

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* 9. Please briefly describe your career goals in health leadership. What are you most passionate about leading? How would the experience of this dialogue series and being the recipient of personal leadership coaching contribute to or support your goals?

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* 10. Please briefly describe your learning objectives in health leadership. Where do you think you need to improve as a leader? What values, skills or competencies do you want to address and develop while participating in the program?

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* 11. Tell us the environment which allows you to best learn and grow? What type of mentorship or coaching do you feel would be most beneficial to your development as a leader? During this series, are you willing to go outside your comfort zone, take risks and be authentic as a leader?

Thank you for completing this registration survey. A member of Faculty will be in touch shortly!