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AUA Leadership Program

2014-2015 AUA Leadership Program Application

Applications for the 2014-2015 AUA Leadership Program class will be accepted through December 31, 2013.

Applicant Statement

Please check the box below before submitting the form.

I hereby apply for the 2014-2015 AUA Leadership Program. I am an Active member in good standing of the American Urological Association and my appropriate geographical Section, and I am 15 years or less out of training (fellowship can be included). I am also currently licensed to practice without restriction. I agree, if chosen, to participate fully in the program and fulfill all of the commitments outlined in this application. I understand that there will be no out-of-pocket expenses. I attest that all statements made in this application are complete and true to the best of my knowledge.

Personal Data












Residency Program/Years of Practice






References
Please provide the names and contact information for two members in good standing of the AUA who can attest to your leadership abilities, reside within your geographical Section and will be providing letters of recommendation on your behalf.

Please be sure to personally contact your references and request them to send their letter to ccallanan@AUAnet.org or:

American Urological Association
Attn: Leadership Program/Member Services
1000 Corporate Boulevard
Linthicum, MD 21090

















Essay
Provide a personal statement describing why the AUA Section should select you to participate in the AUA Leadership Program. Expand on how your characteristics and experience have prepared you for this next step in your career and your commitment level to serving the AUA in the future. Tell us your professional interests, AUA interests, what you hope to gain, etc. Limit your essay to 500 words, typed and double spaced.




If you are unable to upload your documents please email them as attachments to ccallanan@AUAnet.org. Please be sure to include your full name in the email.

Curriculum Vitae
Please provide your C.V. along with an expanded page on personal and professional leadership experiences, volunteerism, political advocacy, interests and a photograph (for publication purposes).




If you are unable to upload your documents please email them as attachments to ccallanan@AUAnet.org. Please be sure to include your full name in the email.

Commitment Agreement
As an applicant for the 2014-2015 AUA Leadership Program, my signature below indicates that, if chosen to participate, I will make myself available for all in-person and online/phone meetings as outlined in the 2014-2015 AUA Leadership Program Instructions. Furthermore, as a chosen participant, I understand that anything less than full participation on my part could result in not graduating with the rest of my classmates at the program's conclusion.

10/2/2014

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