CAMRT Leadership Development Institute – Application

Your completed application and requirements must be received at CAMRT Sunday, June 30, 2024.

Applicant Information:

Name (last name, first name, middle initial) *

CAMRT Registration No.

Discipline / Designation

Home Address

City

Province

Postal Code

Home Telephone

Email *

Professional Information:

Job Title

Department

Employment Institute

Address

City

Province

Postal Code

Work Telephone

Work Email

Education Information

Institution #1

Institution

Major

Degree/Certification Received

Institution #2

Institution

Major

Degree/Certification Received

Institution #3

Institution

Major

Degree/Certification Received

Professional Accomplishments

Please provide a detailed resume of professional activities that demonstrate your leadership potential and capacity for continuous learning. These may include but are not limited to: voluntary activities, awards, committee/project experience, research, professional publication, leadership or educator role at work, education, and personal or professional development.

Leadership Development Institute - Expression of Interest

Your expression of interest should address, in 200 words or less, how your personal and professional skills and accomplishments match the criteria for acceptance to the CAMRT Leadership Development Institute and how you would use what you learn at the Institute.

Letter of Recommendation

Please provide a letter of recommendation from an individual who will support your candidacy for this program. The letter should include their support of your application into the Leadership Development Institute and why they believe you are an excellent candidate for consideration. This letter should be attached, or sent by e-mail to the attention of Phyllis Williams at: pwilliams@camrt.ca

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Certification of Application *

The information contained in this application form is accurate to the best of my knowledge. If I am chosen to attend the CAMRT Leadership Development Institute, I will be able to attend for the full session and commit to volunteering within the year following the Institute with CAMRT or my provincial association.

Agree

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