PLDP application form

PLDP application form

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Webform

The completion of this application form indicates your interest and commitment to the Physician Leadership Development program for 2021-22 (Cohort #4).

This program requires a considerable time commitment from participants. In addition to the six face-to-face learning modules, participants are required to participate in the following:

  • 1.5 hour virtual kick-off prior to Module 1
  • A 360-degree feedback assessment prior to Module 1
  • Five, one-hour individual coaching sessions over the course of the program
  • An action learning project that requires a minimum of 2-5 hours between modules

Please visit the Doctors Nova Scotia website for more program details including program goals, timelines, and application process.

CONTACT INFORMATION

Name
Address
What best describes your primary work setting(s)?

KEY QUESTIONS

Where applicable, please be as specific as possible as to role, impact, and outcome

OTHER

Max 100 words per question

OPTIONAL

Upload requirements

All applications will remain confidential and be reviewed by a selection committee.

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