2022 HIGHER Ground Women's Leadership Development Program Application

The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

Returning?

A A A

2022 HIGHER Ground Women's Leadership Development Program Application

Thank you for applying to the HIGHER Ground Women's Leadership Development Program. The application will ask for different types of information, including one reference, a personal statement, biosketch, and CV/resume. You can close out and comeback to the form and your data will be saved.

* must provide value

First Name

* must provide value

Preferred Name(s)

Last Name

* must provide value

Pronouns (?)

Home Street Address
(include city, state, zip code)

* must provide value

Expand

Preferred Phone Number

* must provide value

Alternate Email (for alumni communications)

How did you hear about this program?

* must provide value

If other, please specify:

Professional Title

* must provide value

Organization

* must provide value

Organization Street Address
(include city, state, zip code)

* must provide value

Expand

What sector do you currently work in?

* must provide value

If other, please specify:

How would you classify where you currently are in your career?

* must provide value

Approximately how long have you been in your current position?

* must provide value

Approximately how many people do you directly supervise?

* must provide value

Professional Biosketch (limit 100 words)
Refer to this resource for how to write a professional biosketch

* must provide value

Expand

Upload CV/Resume

Upload file as word (doc/docx) or pdf with the file name: Last Name_HG2022_CV

* must provide value

Upload file

What range best describes your age?

* must provide value

Which category(ies) describe(s) you best (Choose as many as apply)

* must provide value

White (non-hispanic, spanish, latinx origin)

Hispanic and/or Spanish origin

Black or African American

Asian

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander

Other race, ethnicity, or origin not mentioned

If other, please specify:

* must provide value

What word(s) do you use to describe your gender

* must provide value

What is the highest educational degree/certificate you have obtained?

* must provide value

If other, please specify:

* must provide value

1. Why are you interested in participating in this program? What are your personal and professional goals regarding service and leadership?

* must provide value

Expand

2. What values, passions, and vision do you possess to mobilize leadership for change? Describe a situation in which you took a leadership role and helped affect change.

* must provide value

Expand

3. What assets do you possess as a leader? What assets do you possess as a follower? What might some of your limitations be as a leader? What might some of your limitations be as a follower? How do you contribute to a group to help lead and follow? What approaches, skills, and talents do you seek to develop this program?

* must provide value

Expand

4. Based on the mission of HIGHER Ground as a women's leadership program, what do you hope to gain from this program that will help you make a difference in your career and professional organization?

* must provide value

Expand

Reference Information

First Name		Last Name
Title		Email
Organization

This application must be complete and include the following supplemental documents by November 15, 2021 in order for your application to be considered for acceptance into the program:

*All applicants must submit a references and ensure completed reference is submitted using the appropriate reference form.

Please confirm you acknowledge and understand the following:

* must provide value

I understand and acknowledge the program fee for HIGHER Ground is $1,800. A $250 non-refundable application fee is due at time of application submission. The application fee will be applied toward the total program fee.

The remaining $1550 is due January 1, 2022. I understand and acknowledge that my program fee is non-refundable once I am accepted.

I understand that if accepted, I am responsible for securing appropriate work-release time for all training events.

Application Fee Payment Method

* must provide value

Pay with Card

Pay with PO or Check (please send me an invoice)

Pay with JV (please send me an invoice)

reset

Needs-Based Scholarship Application

I am not eligible for the needs-based scholarship

I am eligible and will complete the needs-based scholarship application form

reset

What is your current employment status?

Full-time

Part-time

Self-Employed

Contracted

Temporary

Laid Off

reset

Please submit a one-page single-spaced essay expressing your need for support and how the HIGHER Ground experience will provide an opportunity for exploration and personal growth.

Upload file

Click Here to be Redirected to the Payment Page

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.