The UAMS Leadership Academy is designed to support the development of UAMS managers and promote relationships across departmental boundaries. This program is accepting applications from individuals who have the desire to develop their leadership skills and to be a positive contributing force at UAMS. The prerequisite for participation in this program is a minimum of one year in a management position - not necessarily in your current UAMS position, but at some previous point during your career. It is also recommended that applicants have completed the UAMS Leadership Bootcamp and Essentials courses. Leadership Academy is a six-month hybrid program consisting of once a month half-day educational sessions, online content and assessments, and monthly brown bag sessions.

Please complete this application and return it, along with the required documentation, to Dr. Wesley Alford ([email protected] or slot 566) by January 15, 2016.

I, ______have completed the prerequisites and would like to participate in the UAMS Leadership Academy.

Participation in the Leadership Academy requires a significant time commitment in and out of the classroom. Each half-day educational session requires the participant to complete pre-work consisting of readings and online assessments of the material to be discussed in the session. The brown bag sessions are held monthly and last approximately an hour and a half. In order to graduate from the Leadership Academy you must complete at least 90% of the sessions and achieve passing scores on the online assessments.

I understand the time commitment necessary and have discussed with my supervisor ways to make time and other resources available during the year to fully allow me to participate in the program.

Yes No

My supervisor and I believe that I will benefit from and contribute to the UAMS Leadership Academy. We understand the time commitment necessary and have discussed ways to make time and other resources available during the year to fully allow me to participate in the program. We also understand the cost of the program to be $275.00 and agree to provide payment.

Applicant Signature______Date______

Supervisor Signature______Date______Application Checklist To complete the application process, please return the following documents to Dr. Wesley Alford ([email protected] or mail slot 566) by January 15, 2016.

 Completed and signed application (signed by applicant and supervisor)

 Your response to the following questions using no more than 500 words.

o Why is the development of your leadership skills important to you? How will the skills learned in this course help you in your current and future positions?

 Current resume or Curriculum Vitae

 The completed Participant Profile (see below)

2 Participant Profile

Name______Last First Middle

Preferred Name______

Title______

Department______

Phone ______Email ______

Number of Direct Reports ______Number of Years in a Management Position___

SAP Number______Employed at UAMS Since______

Favorite leisure activities ______

One unusual or fun fact about yourself ______

Do you have special dietary needs? If yes, please describe below. ______

Do you need special accommodations? If yes, please describe below. ______

3 Leadership Academy Application– (Formerly Management Academy) UAMS Organizational Development