Application for Leadership Academy: Cohort IV

Dear Applicant,
Thank you for your interest ACC's Leadership Academy program. The Leadership Academy program is a two-year leadership development program that serves to further develop early-career members of the ACC. The robust programming addresses various leadership-specific competencies, in order to ensure each appointee is highly qualified to lead the cardiovascular profession, while also fulfilling the ACC’s current and future leadership needs.

Designed with member-needs, and an evolving healthcare system in mind, the programming provides a broad understanding of leadership styles and skills. Additionally, the curriculum addresses varied perspectives on critical leadership challenges; while also providing an awareness of concepts and techniques relevant to leading effectively within their respective institution, and within the ACC. In order to be considered for admission into Cohort IV, all application materials are due by Monday, December 2, 2019. A complete application requires the following:

1. Applicant's Submission of the Online Application (questions located further below).

2. Statement of Support from an ACC Member Leader (250-word): Please address how the applicant will benefit from being a member of the Leadership Academy program, and how he/she considers serving the College in the future with the leadership skills developed within this program. Please send statement of support by Monday, December 2 to leadership_academy@acc.org with 'Leadership Academy - Cohort IV' in the subject line.

Eligibility Qualifications: ACC members meeting the following qualifications are invited to apply for Cohort IV of Leadership Academy:

A Fellow-in-Training, Fellow or CV team member within the first seven years out of specialty education, residency, or training.
Active within a domestic or international chapter.
Active within at least one member interest section.
Participated in at least one live program within previous twelve months (*included, but not limited to the Annual Scientific Session, ACC educational course(s), ACC’s Legislative Conference, etc.).

Please send any questions you may have to: leadership_academy@acc.org.

Thank you kindly,
ACC's Leadership Academy Program Team

1. Applicant Information: *

Applicant's First Name:	*
Applicant's Last Name:	*
Applicant's Email:	*
Applicant's Cell Phone (including area code):	*
Applicant's Gender:	*

2. Eligibility Criteria: *

	Yes	No
I am an ACC member.	I am an ACC member. Yes	I am an ACC member. No
I am a Fellow-in-Training, Fellow or CV team member within the first seven years out of specialty education, residency, or training.	I am a Fellow-in-Training, Fellow or CV team member within the first seven years out of specialty education, residency, or training. Yes	I am a Fellow-in-Training, Fellow or CV team member within the first seven years out of specialty education, residency, or training. No
I am active within a domestic or international chapter.	I am active within a domestic or international chapter. Yes	I am active within a domestic or international chapter. No
I am active within at least one member interest section.	I am active within at least one member interest section. Yes	I am active within at least one member interest section. No
I have participated in at least one live program within previous twelve months (*included, but not limited to, the Annual Scientific Session, ACC educational course(s), ACC’s Legislative Conference, etc.).	I have participated in at least one live program within previous twelve months (*included, but not limited to, the Annual Scientific Session, ACC educational course(s), ACC’s Legislative Conference, etc.). Yes	I have participated in at least one live program within previous twelve months (*included, but not limited to, the Annual Scientific Session, ACC educational course(s), ACC’s Legislative Conference, etc.). No

Comments:

3. ACC Participation: Please briefly describe your recent participation in an ACC activity within the past 12 months (participation in Annual Scientific Session, ACC educational course(s), ACC's Legislative Conference, ACC Committee, Chapter or Section service, etc.). *

4. **Institution Detail (*current):** *

Institution:	*
Institution City:	*
Institution State:	*
Institution Country:	*

5. CV Training Information: *

CV Fellowship Training Institution and/or CV Team Training Location:	*
Month/Year Training Completed (xx/xxxx):	*

6. Primary Focus: (check all that apply) *

7. Please list current and/or previous leadership roles held on behalf of the ACC. *

8. **Personal Statement of Interest (250-word max): Please address why you are interested in the ACC’s Leadership Academy program, and your ambitions of leadership at the ACC going forward.** *

9. Please paste a copy of your CV in this section. *

10. Please identify who will be submitting a statement of support (via email) on your behalf. One statement from an ACC Member Leader is required. Please ensure the 250-word statement is sent by Monday, December 2, 2019 to: leadership_academy@acc.org with 'Leadership Academy - Cohort IV' in the subject line.

Support to be submitted by (first name, last name):	*
Position	*
Supporter's email address	*

ACC requests information from its members (and this program's applicants) on ethnicity and race as part of the College’s aim to develop a more diverse and inclusive cardiovascular workforce. Your support in this effort is greatly appreciated.

11. Would you describe your ethnicity as Hispanic?

12. Please indicate your race (check all that apply):

Asian
Black/African American
Native American/Alaskan Native
Native Hawaiian/Other Pacific Islander
White (includes people of origins from Europe, the Middle East, or North Africa)
Decline to provide
Other (please specify):