2022 CTAHE Leadership Coaching Application

The Connecticut Association of Healthcare Executives has partnered with YardeZone to offer COMPLIMENTARY career coaching and leadership development services to our members. A limited number of applicants will be chosen for this exclusive program. Selected applicants must take a standardized leadership assessment that will be reviewed throughout the program with a leadership/executive coach. Members of the cohort will be required to attend scheduled quarterly coaching sessions. The coach will also be available to you as needed. Participants may also take advantage of an optional service this year- if a participant's supervisor wants to take an assessment, the coach will meet with both parties to discuss how they can improve efficiency in their professional relationships. Applications for the program are due by 5 PM on Wednesday. All candidates must be fully vaccinated against COVID-19 by the start of the program. December 15th. Please reach out to Ysmael Albert Peguero at ysmael.peguero@outlook.com for any questions.

Full Name

Email Address

Current Title

Organization's Name

Are you a member of ACHE?

Yes

No, but I will become a member before January 2022

Best Contact Phone Number

Are you fully vaccinated against COVID-19?

Letters of Recommendation

Please request a letter of recommendation from your immediate supervisor. You may also submit up to one additional letter of recommendation from someone other than your supervisor for consideration. If you are unable to use your current supervisor as a reference, please note the reason in the specified section. In the area below, please let us know who you are using as a reference. Please ask your references to email their letters of recommendation to Ysmael Albert Peguero at ysmael.peguero@outlook.com. They can include the recommendation in the body of the email or as an attachment. The subject line of the email from the references should be "Recommendation for CTAHE Leadership Coaching for YOUR NAME"

Name of Reference

Title

Years Known

Contact Number

Reference Email Address

Is this your immediate supervisor?

Yes

Do you have a second reference?

Yes

Please upload your current resume or CV and proof of your COVID vaccine status.

Drop your files here

Please check here if you agree to the below terms.

I understand that only completed applications will be considered. I understand that I need to contact my reference(s) and have them submit their recommendation to Ysmael Albert Peguero at ysmael.peguero@outlook.com I understand that this program requires my active participation. I plan to fully engage with the program and understand that my space in the program can be forfeited if I am not actively participating. I certify that the information contained in this application is accurate and acknowledge understanding and agreement that the selection of participants is within the complete and sole discretion of the CTAHE Membership Committee.

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