Executive Fellows Program Application

Tell Us About You

First Name (required) Last Name (required) Home Email
Address (required) City (required)
State (required) Zip (required) Home Phone
Title License# and State Issued Type of license (RN, LPN, LVN)

Tell Us About Your Facility

Corporation (required) Facility/Community Name (required) Nurse Leader Executive's Name
Facility/Community Address (required) City (required)
State (required) Zip (required) County
Facility Phone (please include extension) Work Email (required)

Program Cost: $2500/person for entire year-long program (NADONA members) and $2000/person for entire year-long program (NADONA Corporate Member Facilities).

Nurses and other healthcare professionals that are not NADONA members may also apply to the program. Fees for non-members are $3500/person for the entire year-long program.

How Would You Like to Pay?

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Name as it appears on card
Billing Address (if different from above) Card# Expiration Date

Goals, Strengths, Areas for Improvement

For the participant:

What goals do you seek to achieve by taking this class?

Where in your leadership role, do you need the most help?

What would you consider your strength(s) to be?

What areas of leadership do you want to improve in?

For the Nurse Leader's Reporting Management:

What goals do you seek for your Nurse Leader to achieve by taking this class?

What would you consider your Nurse Leader’s strength(s) to be?

What areas of leadership would you like to see improved in your Nurse Leader?

Executive Fellows Program Schedule Program Format

  • Ten, Monthly Webinars – Each webinar will be 90-minutes in length (30 mins didactic, 30 mins. application, and 30 mins Q&A).
  • Books – There are six required books for this program. The course is broken up into three main areas: Self, Organization, and Change. There are two books that accompany with each section.
  • Case Studies – Throughout the course there will be case studies to apply the learning in a work setting. We will review the case study on our monthly webinars.
  • Quizzes – For each topic, there will be a pre/post quiz to measure your level of learning.
  • Required Reading & Discussion Questions – Each month there will be required reading and discussion questions. Participants must come to the webinar prepared to engage in conversation and ask questions.
  • Project – Each participant will be required to deliver a project that involves data, field testing and conclusion.
  • Alumni Reception – At the 2019 NADONA Conference, there will be a graduation ceremony for the Class of 2018. This group will then become part of the Fellows Alumni and help mentor the next class through the program.

All webinars are from 6:00-7:30 EST/ 4:00-5:30 MST

Class Schedule TBD and Published at a later date

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