CAMRT Leadership Development Institute – Application

Your completed application and requirements must be received at CAMRT by, June 30th.

Applicant Information:

Name *

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

For the education you have acquired, please provide the Name of the Institution, your Major, the Degree/Certification received, and the year completed.

Application Criteria

Contribution and Innovation

Please provide examples of any project, contributions, initiatives or improvements you have started or participated in, that is beyond the expectation of daily duties, that improve the work environment.

Personal and Professional Development

Please provide information on any formal education beyond entry to practice (certificates, diplomas, degrees), or any continuing personal/professional development (CAMRT courses, workshops, personal learning seminars, research participation, conferences, etc.)

Leadership within the Practice of the Profession

Please provide examples of formal or informal leadership activities in the profession that you have been involved with. This could include educating others (lunch and learns, webinars, conference presentations), leading in your workplace (equipment superuser, preceptor, site ambassador), a job role (team lead, practice lead, supervisor), etc.

Volunteerism

Please provide examples of your involvement on a committee or council (CAMRT, regulatory body or hospital/clinic), union involvement, hospital foundation, educational programs or relevant volunteerism outside the profession.

Expression of Interest

In 200 words or less, your expression of interest should address any information that has not been included in the above categories. It should also convey your desire to participate in the LDI, as well as your personal interest in developing your leadership potential.

Letter of Recommendation

Please provide a letter of recommendation from an individual (e.g., manager, mentor) who supports your candidacy and application for the LDI. The letter should include why they believe you meet the criteria and would be 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.

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