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Participant Application

Please fill out the online application below completely and attach the required documents. If you have any questions, or issues, please contact the ACP at

If you would prefer to submit a PDF application, please download the application below and send it to upon completion.

Download Application

ACP Leadership Academy Participant Application

I understand that the success of the ACP Leadership Academy depends on my active participation in the program. I agree that, if selected for the program, I will attend both of the scheduled face-to-face meetings, all webinars, conference calls and phone meetings with my mentor. I will complete my project by the end of the program and present it at the ACP Annual Congress in November, 2016. I understand that I will be responsible for my own travel expenses and lodging and agree to pay the registration fee of $3500. Once I have completed the program with the required attendance and completion of my project, I may have $500 refunded to me or donate those funds to the ACPF if I choose. 

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