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The ICE Diversity Leadership Program - Application
Please fill out ALL fields & questions. THE DEADLINE FOR THIS APPLICATION IS DECEMBER 1ST, 2023
PLEASE E-MAIL INFO@ICE.PHYSIO WITH QUESTIONS
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Name
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Your answer
E-mail address
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Your answer
Phone number
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Your answer
Please list your ethnicity. This question will NOT be used to judge your application. This information will be used to inform future outreach for this opportunity.
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Your answer
Are you currently licensed to practice as a physical therapist?
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Yes
No
Describe one long term goal you have within or that relates to the profession of physical therapy (500 word limit).
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Your answer
Describe one challenge you have come up against and what information you have gained from this experience? (500 word limit).
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Your answer
How do you believe this program and the Institute of Clinical Excellence specifically can support your personal and professional goals? (500 word limit)
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Your answer
What barriers do you perceive in the field of physical therapy to people of color? (This question is OPTIONAL and will NOT be used to judge your application)
Your answer
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