Reference Letter Form

{"key":"reference_letter","type":"text","label":"Full name","name":"referee_name","required":true}

{"key":"reference_letter","type":"email","label":"Email Address","name":"referee_email","required":true}

{"key":"reference_letter","type":"text","label":"Telephone number","name":"referee_telephone","required":null}

{"key":"reference_letter","type":"text","label":"Relationship with candidate?","name":"referee_relationship","required":true}

{"key":"reference_letter","type":"text","label":"How long have you known candidate?","name":"referee_howlong","required":true}

{"key":"reference_letter","type":"text","label":"Institution\/Organization","name":"referee_institution","required":true}

Please respond to the three questions below in the textboxes provided- this is required. If you wish, you may also upload a Word document with the same content, however, uploading the document by itself without completing the textboxes is not permitted.

{"key":"reference_letter","type":"textarea","label":"Please comment on the candidate\u2019s professional ability","name":"referee_question_1","required":true}

Please comment on the candidate’s professional ability*

{"key":"reference_letter","type":"textarea","label":"Please describe the candidate\u2019s understanding of and commitment to health equity.","name":"referee_question_2","required":true}

Please describe the candidate’s understanding of and commitment to health equity.*

{"key":"reference_letter","type":"textarea","label":"Please provide your perspective on the candidate\u2019s leadership qualities and potential","name":"referee_question_3","required":true}

Please provide your perspective on the candidate’s leadership qualities and potential*

The referee may choose to upload a document with the same text as above, but please note, applications that do not complete the 3 textboxes above but submit an attached letter WILL NOT be considered a complete application.

{"key":"reference_letter","type":"file","label":"Reference Letter","name":"referee_attach","required":null}

Accepted file types: PDF, DOC, DOCX

01.pdf