Education

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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 leadership@acpmail.org.

If you would prefer to submit a PDF application, please download the application below and send it to leadership@acpmail.org 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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