HPLA Application 2025-26 HPLA Application Applicant Name(Required) First Last Phone(Required)Email(Required) Mailing Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Please answer the questions below and submit your responses. You may also upload an optional Letter of Recommendation and a resume. Limit each response to 300 words. Employer(Required)Job Title(Required)Years of Practical Experience(Required)0-5 years6-10 years11-15 yearsMore than 15 yearsWhy are you interested in participating in the Leadership Academy and what are your expectations?(Required)Are you preparing to move to a leadership position where you will oversee others?(Required) Yes No Is your current employment your first career position?(Required) Yes No Do you currently supervise one or more people?(Required) Yes No Are you at the end of your career and preparing your legacy?(Required) Yes No Are you currently a member of the Michigan Pharmacists Association?(Required) Yes No Please describe the current stage of your career and leadership level(Required)What are your current leadership responsibilities? *(Required)Include a description of your current role and responsibilities including the number of people who report to you now. Please note that having other healthcare professionals directly reporting to you is not a requirement for acceptance into the Leadership Academy.What is your leadership goal?(Required)What is your career goal?(Required)What leadership challenges are you, your team and organization currently experiencing?(Required)What student, professional, or community organizations have you been a member of, and what leadership roles have you held?(Required)Include memberships in student, professional, or community groups (e.g., civic, social, religious, athletic, etc.). Be sure to describe any leadership experiences or responsibilities you held within these organizations.File UploadsResume UploadAccepted file types: txt, doc, docx, rtf, pdf, Max. file size: 2 MB.Upload your CV or Resume.Letter Of RecommendationAccepted file types: txt, doc, docx, rtf, pdf, Max. file size: 2 MB.CAPTCHA
