US Leadership Journey 2021

Application Form

Your application packet is complete when you have submitted all the components of this form. WomenLift Health is committed to bringing together a diverse cohort of women leaders.

Please complete all the fields below, except for the fields indicated as optional. Your responses will be automatically saved if you return to the form later, until the point at which you submit your application.

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To see Leadership Project guidelines, refer to the “How to Apply” section of our application page.


Leadership Snapshot Questions (300 words max)

I certify that my answers are true and complete to the best of my knowledge. I have reviewed the requirements and commitments of the Leadership Journey. I understand that it is compulsory to attend all virtual and in-residence components of the WomenLift Health Leadership Journey.

I understand and agree that:

  1. In connection with my application to and participation in the WomenLift program at Stanford, I may provide personal information to WomenLift, including my name, contact information, employment data, biographical data, training data, leadership assessment data, and other information about me (collectively “Personal Data”). I agree that WomenLift and its affiliates and vendors (including the Center for Creative Leadership and Clear Outcomes) may (a) use my Personal Data in connection with the evaluation of my application, administration of the WomenLift Health Leadership Journey program, evaluation and improvement of such program, and (b) disclose my Personal Data to third parties (including the sponsor, the Bill and Melinda Gates Foundation) in furtherance of such evaluation, administration and improvement-related activities, provided that any recipient of my Personal Data will be bound by appropriate confidentiality obligations; and provided further that only aggregate, de-identified leadership assessment data will be provided to third parties for such purposes.

  2. WomenLift will treat my Personal Data in accordance with the Stanford Online Privacy Policy (https://www.stanford.edu/site/privacy). WomenLift may combine my Personal Data with data of other individuals, and publicly disclose aggregate, anonymous information about the program and its participants, but my Personal Data in identifiable format will not be publicly disclosed without my prior permission.

    If I am later selected to participate in the program, WomenLift will ask to post my bio on the public WomenLift Health website and on publicly available social media sites; and I will be requested (but not required) to provide a photo to accompany my bio on such sites.

 

Supervisor Information


Optional Supplemental Questionnaire

Completing this supplemental questionnaire is completely optional. The demographic information requested is intended to better understand and strive for diversity, equity, and inclusion in our applicant pool. You may skip any question you do not feel comfortable answering. No individually identifiable information will be shared.

 


I do not have a disability.Deafness or severe hearing impairmentBlindness or severe visual impairmentA condition that substantially limits physical activity such as walking, climbing stairs, lifting or carryingA learning difficultyA long-standing psychological or mental health conditionOther (including any long-standing illness such cancer or HIV)Prefer not to answer.