Hospital or Academic Affiliation
Are you a current member of AAWEP? (Required)
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 tonominate for LeaP? If so, share their names with us! (Please indicate if you would prefer to remain anonymous).