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CAHIP Emerging Leader Program Application

* Name

* Company

* Office Address

* Email

* Telephone

* CAHIP Chapter

Undergraduate (school and degree)

Postgraduate (school and degree)

Are you a current CAHIP/NABIP member?

Yes
No

Have you attended any CAHIP events?

Yes
No

How many years of experience do you have in the health insurance industry?

In a brief personal statement, tell us about yourself and comment on your views about leadership.

Why do you want to participate in a leadership development program?

Please highlight any current or previous leadership programs you are/have participated in.

Where do you see yourself professionally in the next 3-5 years?

What do you hope to gain from this experience from a personal and/or professional basis?

REFERENCE #1: Name, Company, Position, Email, Telephone

REFERENCE #2: Name, Company, Position, Email, Telephone

Please upload a current resume (Word or PDF format).

Please upload a current headshot (max size 5MB jpg format).

Please upload a letter of professional reference (Word or PDF format).