Rural Colorado Primary Care Leaders Program Scholarship Application Page | Colorado Rural Health Center

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Rural Colorado Primary Care Leaders Program Scholarship Application

Please complete the following information to be considered for a scholarship opportunity for this program.

Name*
Specialty*
Employer*
Position/Role at Organization*
Preferred Phone Number*
Email Address*
Mailing Address*
City*
Zipcode*
Length of time with current employer*
Do you supervise employees?*
Tell the story (share refelections) of your personal developmental journey as a leader. Describe one specific experience that influenced your current perspective on leadership.*
How will your values and passion lead you to make an impact as a leader?*
Comment on how this program might help you achieve your goals.*
What key leadership challenges do you currently face?*
How have you tried to overcome these challenges? Give a brief example.*
What healthcare policy/regulations related to the work you do have been particularly challenging? How have you faced that challenge?*
In the past two years, have you advocated for policy or programmatic change in primary care?*
Please briefly provide an example of what you did.*
In the past two years, have you attended any training in primary care leadership?*
Please briefly describe an example of what you did.*
What do you expect to develop during your participation in this program?*

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3033 S Parker Rd #606
Aurora, CO 80014

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