2009 Palatucci Advocacy Leadership Forum Online Application

This form must be completed and submitted online in order to apply to participate in the Palatucci Advocacy Leadership Forum. Please review the Application Process and Guidelines for information on the Forum and what is expected of participants.

Instructions

• Fields with a red asterisk (*) must be completed or the form cannot be submitted.
• Your contact information has been automatically filled in with information from the AAN member database. Please review it to make sure it is up to date and enter any changes. All information, including your notification letter, will go to this address.
• The demographic information is optional, but will help us better understand the characteristics of members applying for this program.
• The application asks five narrative questions:
• Why do you want to be chosen for the Palatucci Advocacy Leadership Forum to be trained as an advocacy leader?
• Where does your strongest advocacy interest lie?
• How do you envision applying the skills you learn at the program?
• What past leadership or advocacy experience do you have that relates to healthcare or issues of importance to you?
• Provide one example of a time you have demonstrated leadership skills?

Tips

• You may want to save your essay answers in a Word document in case there is any problem with the electronic submission process.
• If you need to go back to a previous page in the application, use the “Step” navigation links above or the “Back” button on your Internet browser.
• You may click the save button at any time to save your progress. You can choose to save your application and return to it as many times as needed up until the deadline. However, once you click submit, you will no longer have access to your application.

You will be able to save your application as you go along. Your application will not be completed until you hit the submit button. After you have completed the form, you will have a final opportunity to review and edit your answers before you submit them. You will receive confirmation that your submission has been received.

Applications must be received by the AAN by 11:59 p.m. midnight CDT, September 21, 2008 in order to be considered for the 2009 Forum.

If you have any questions about this application or the Forum, please contact Melissa Larson at mlarson@aan.com or (651) 695-2748.

Start or continue the application form