AAWEP Leadership Pipeline Project (LeaP) Interest Form

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Name

Email Address

Hospital or Academic Affiliation

Are you a current member of AAWEP? Yes No

Please list any current or previous ACEP positions held (eg, councilor, committee chair, section chair, etc.).

Describe any current or previous ACEP taskforce involvement.

List other national, regional, or local leadership positions held.

What leadership opportunities might be of interest to you in the future?

What barriers might prevent you from attaining future leadership positions?

Please describe your optimal timeline for attaining these leadership positions.

Are there specific ways in which ACEP/AAWEP can support you in reaching your leadership goals?

How were you referred to this program?

Are there other women you'd like to nominate for LeaP? If so, share their names with us! (Please indicate if you would prefer to remain anonymous).

Submit

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