MTEP 2.0 Leadership Academy Interest Survey
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Email *
First name *
Last name *
Institution *
Position *
Current leadership activities with MTEP (e.g., change agent, member of a leadership hub, subhub, or planning group), if any
Other current leadership activities (e.g., department/university committees, local or national professional organizations), if any
Specific goals for improving your leadership (e.g., known areas for improvement in current roles, additional roles you would like to pursue *
Which of these topics would you be interested in pursuing? (Select all that apply.) *
Required
When would you prefer that the Leadership Academy begin?
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Which of the following options would you prefer?

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Which of the following options would you prefer?

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How much time could you dedicate to reading or practice implementation tasks in between scheduled meetings to help you reach your goals?
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How interested would you be in adding a leadership certification to your CV and annual reports?

Not interested
Very interested
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How interested would you be in adding leadership microcredentials to your CV and annual reports?

Not interested
Very interested
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Would offering a stipend increase your commitment to participating?
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What else would you like us to know about your interests, availability, or preferences related to this potential MTEP Leadership Academy?
A copy of your responses will be emailed to the address you provided.
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