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Are you interested in becoming a Fellow? Or do you know someone who would benefit from the program? Applications for the 2009-2010 AHA Patient Safety Leadership Fellowship are now being accepted. Reserve your space today. If you have questions or need assistance, call Shawn Foster at (312) 422-2933.

Key Dates

Application Requirements

I. Applicant Information

Please click here to download the application form.

II. Computer Literacy
At what level of personal computer expertise do you consider yourself: No experience, Beginner, Intermediate, or Advanced?

III. Resume or Curriculum Vitae

IV. Essay Questions: (one page or less for each essay)

1. What is your vision for a safe and healthy organization? How does this vision fit with your personal and professional goals?
2. What do you consider to be your most significant contributions to improving patient safety?
3. We are asking Fellows to be change agents. What will you do in the year ahead to advance the culture of patient safety and improve quality of care within your organization?

V. Action Learning Project Proposal: (three to four pages)

• Project title/location
• Statement of project objectives
• A two-paragraph project summary (to be used for publication purposes)
• How your project will advance patient safety and improve health outcomes. How will you measure results?
• The impact of your project on existing patient safety initiatives

Please note: It is understood that all proposals are works in progress. Selection of an applicant as a Fellow does not necessarily mean acceptance of the Action Learning Project. It may undergo modification to ensure that it fully meets program objectives and is mutually acceptable.

VI. Letter of Organizational Support
You are required to submit a one-page letter from the chair, president (or other appropriate executive) of your organization indicating organizational support and commitment (time and resources) for the Action Learning Project and for your participation in the Patient Safety Leadership Fellowship.

VII. Letter of Reference Guidelines
All Fellows are required to submit two letters of reference with their application. Each of these letters must include the following:

• Fellowship applicant's name
• Reference name, title, organization, address, phone, and fax
• Reference signature and date
• Letters of reference should address the following questions: 
     1. In what capacity do you know the applicant?
     2. How long have you known the applicant?
     3. Do you believe this individual has the potential to be a change
         agent for patient safety? If so, why? Please elaborate on your
         support of the candidate and provide examples if possible.

SUBMISSION

Please submit two copies of your application (and a copy on CD or via e-mail) to:

AHA Fellowship Programs
Attn: Shawn Foster
One North Franklin Street, Suite 2800
Chicago, IL 60606
fellowships@aha.org

Your application must include:
1.  Your answers to all (3) essay questions
2.  A signed letter of support from your organization (Section VI)
3.  Two completed references (Section VII)
4.  A 3” x 5” black and white head shot photo of yourself facing forward
     (jpeg at least 300 dpi)
5.  An electronic copy of your application and photograph

Time Commitment
Participants must invest the time and energy needed to complete all aspects of the Fellowship program, including implementing the Action Learning Project, attending all required meetings, submitting progress reports, and participated in scheduled on-line meetings. Up to 20 percent annual release time is recommended from the Fellow’s employer to satisfy the program requirements.

Tuition and Costs
Tuition includes all course materials and onsite meeting fees, including registration at two national conferences. Tuition is due upon acceptance to the program. Fellows may also apply for partial scholarship assistance.

Cancellations and Withdrawals
All cancellations and withdrawals must be submitted in writing.  For cancellations or withdrawals received on or before June 1, 2009, tuition will be returned, less a processing fee of 10 percent.  For cancellations made after June 1, 2009, and on or before June 30, 2009, tuition will be returned less a processing fee of 25 percent.  As of July 1, 2009, no refunds will be made.

Scholarships & Financial Assistance (Available)

National Patient Safety Foundation Leadership Fellowship Scholarship
The mission of the National Patient Safety Foundation (NPSF) is to improve the safety of patients. As a Patient Safety Leadership Fellowship Program Partner, NPSF will provide up to two partial scholarships to individuals from organizations with financial needs and who demonstrate a strong commitment to improving patient safety. For more information and scholarship criteria, please visit www.npsf.org.

ASHRM Scholarship
Active members of the American Society for Healthcare Risk Management (ASHRM) may be eligible to submit a request for scholarship with their fellowship application. ASHRM scholarships are limited to those who are eligible for ASHRM fellow (FASHRM) status, including five years as an ASHRM member.  The scholarship is made available by the generous support of the ASHRM Foundation.

Active members of American Organization of Nurse Executives (AONE) and ASHRM are eligible for special discounts. Organizations that have previously sponsored fellows are also eligible for discounts.

For general inquiries about scholarships and financial assistance, contact Shawn Foster at 312-422-2933.

A Special Note for the Disabled
No individual with a disability will be excluded, denied services, segregated, or treated differently from others because auxiliary aids or services are lacking. If you need any of the auxiliary aids or services identified in the Americans With Disabilities Act, please describe your particular needs in writing.