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Signature Event

September 18, 2023

Nashville Healthcare Sessions: Kick-Off Day & Finance and Innovation Day
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Leadership Health Care
Leadership Health Care
Council Fellows
Council Fellows
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Media & Resources

Council Fellows Application

Application Form

2024 Council Fellows Application

"*" indicates required fields

Step 1 of 5

20%

Personal Information

Name:*

Prefix First Last Suffix

Gender:*

Preferred Pronouns:*

Race:*

Ethnicity:*

Nickname/Familiar name for Name Badge:*

Your Preferred Initials (i.e., JWR):*

Your Preferred Name for Media Releases (i.e., Jane Smith):*

Home Address:*

Street Address

Home Address 2

Street Address 2

Home Address City*

City

Home Address State*

State

Home Address Zip*

Zip Code

Home Address Country*

Country

Mobile Phone:*

Primary Email:*

Professional Information

Position/Title:*

Company/Organization:*

Parent Company (if applicable):

Business Address:*

Street Address

Business Address 2

Street Address 2

Business Address City*

City

Business Address State*

State

Business Address Zip*

Zip Code

Business Address Country*

Country

Business Phone:*

Assistant Name:

First Last

Assistant Email:

Assistant Phone:

Assistant Title

Number of Direct Reports*

Job Title of Person to Whom You Report

General Information

Preferred Mailing Address*

This address will be used to send the official acceptance letter to the program.

Business Address

Home Address

Years with Current Employer*

What category best describes your industry sector?*

Please describe your industry:

Is your organization considered a government entity?*

Yes

No

Is your company a member of the Nashville Health Care Council?*

Yes

No

Unknown

Are you a full-time practicing clinician?*

Yes

No

Are you in need of scholarship assistance to participate in the Council Fellows program?*

Yes

No

Provide a brief description of your organization and/or business unit: (500 words max)*

Briefly describe your current role and responsibilities: (500 words max)*

Write a short bio about yourself: (300 words max)*

Please upload your resumé*

Accepted file types: pdf, docx, doc, Max. file size: 50 MB.

Personal Goals

If selected, what do you hope to gain by participating in Council Fellows?*

Please identify a single challenge, issue or problem you feel is critical to solve to transform the health care industry: (maximum of 1000 characters)*

Participation Requirements

Fellows 2024 Session Dates

2024 Class Welcome Reception: Wednesday, January 24, 2024
Opening Retreat: Thursday, January 25-Friday, January 26, 2024
Session 1 (virtual): Friday, February 9, 2024
Session 2 (in-person): Thursday, February 15 – Friday, February 16, 2024
Session 3 (virtual): Friday, March 8, 2024
Session 4 (in-person): Thursday, March 28 – Friday, March 29, 2024
Session 5 (virtual): Friday, April 5, 2024
Session 6 (in-person – Washington, D.C.): Wednesday, April 17 – Friday, April 19, 2024
Session 7 (virtual): Friday, May 3, 2024
Closing Retreat (in-person): Thursday, May 16 – Friday, May 17, 2024

Will you be able to fulfill the commitment of attending the opening retreat, seven Fellows classes and closing retreat?*

Yes

No

Do you have the support of your employer for the time required to participate in this program?*

Yes

No

Industry and Leadership Background

Please list any recent or current community and/or board leadership positions:*

References

Please enter contact information for two references below. After submitting this application, your references will receive a link to submit a letter of recommendation on your behalf. Once letters of recommendations have been received, you will be notified via email and your application be considered complete.

Alternatively, you can send them to this page to fill out the reference form.

First Reference Name:*

First Last

First Reference Title:*

First Reference Company:*

First Reference Email:*

First Reference Phone:*

Second Reference Name:*

First Last

Second Reference Title:*

Second Reference Company:*

Second Reference Email:*

Second Reference Phone:*

Tuition Payment

Payment for Fellows tuition is due upon acceptance into the program and must be received by the Nashville Health Care Council no later than Friday, January 12, 2024. Lack of payment might impact your participation in the Council Fellows program, which begins Thursday, January 25, 2024.

Phone

This field is for validation purposes and should be left unchanged.

Purpose Statement

We exist to strengthen and elevate Nashville as the Healthcare City.

View Mission

About
Health Care Industry
- Economic Impact
- Industry Timeline
Leadership Health Care
Council Fellows
Media & Resources

© 2023 Nashville Health Care Council

500 11th Ave. N., Suite 200, Nashville, TN 37203

615-743-3140