Please read the instructions below before you begin filling out the Application Form
Please note that the form has several different fields to fill spread over 7 pages. It is an intensive process and the MDI program organisers propose that you complete the application as a team (2-3 people).
Before you start filling in this application make sure you have the following information:
1. Primary Health Priority (in your Country/County or Institution)
a. Examples: (Communicable or Non-communicable) Disease prevention & control; Maternal & Child Health; HIV/AIDS and STI; Tuberculosis; Expanded program on immunization etc
2. Organization Information
a. Physical and Postal Address, Email Address, website
b. Telephone, Fax
c. Number of patients/clients served per year;
Number of sites, clinical staff, admin staff, and other staff;
d. Which sector is your organization: Govt, NGO, Private?
e. Organization Type: Local Non-Government, National Non-Government, International Non-Government, Faith-Based, Community-Based, Educational Institution, Local Health System, Regional Health System, National Health System, Governmental Institution, Hospital, Other (please specify)
3. Team Members' information
a. Personal Information: Name, Email, Phone, Postal Address, Gender
b. Role in Addressing Health Priority
c. Have you ever applied to MDI before?
d. Education: Highest level of education attained;
Name of Institutions attended, years attended, name of degree or certificates received.
e. Professional Development: List any management or leadership training you have attended within the last 3 years (e.g., conferences and seminars) relating to your work as a health care executive
f. Employment History: Total number of years worked; List other positions held in the health care industry – Position/Title, Company/Organization, Number of Years
g. Leadership Involvement: List any community and/or health care organization(s) in which you are involved in a leadership capacity, including the scope and length of time of your participation. Note: A minimum of 3 – 5 years leadership involvement is required;
Name of Organization;
Dates of Participation;
Leadership Role / Title.
h. Choose one organization and describe, in detail, your leadership role.
Repeat for EACH Team Member / Applicant
a. Team to Jointly Respond: What are the major health care needs, challenges and priorities facing your nation, region or community? What is your entity, department, organization, team or partnership doing, or else are planning to do, to respond to these challenges and to attend to these health priorities?
b. EACH Team member to Respond: Describe your personal role and responsibilities in confronting these challenges.
c. EACH Team member to Respond: What do you anticipate as being the benefits to your management team from participating in the Management Development Institute? What do you, as a member of the team that is attending, expect to gain?
a. Commitment Letter from Organization: Upload (Scanned and in PDF) a letter of recommendation from your organization will be included along with the team's program application.
b. Commitment Form: Download the Commitment Form. Print, complete and upload the signed form.