Reference Letter Form

Thank you for agreeing to provide a reference for this applicant to the Equity Initiative Fellowship Program. Your reference will help us better understand the candidate’s professional experience, leadership qualities, commitment to health equity, and potential contribution to the Fellowship cohort.

Please complete the textboxes below. You may also upload a reference letter with the same content, however, uploading a document alone without completing the required textboxes will not be considered a complete reference submission. If you experience any issues, please contact info@equityinitiative.org.

{"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, including country code","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}

1. Professional Ability*

{"key":"reference_letter","type":"textarea","label":"Please comment on the candidate\u2019s professional ability, including the quality of their work, areas of expertise, judgment, reliability, and ability to work with others.","name":"referee_question_1","required":true}

Please comment on the candidate’s professional ability, including the quality of their work, areas of expertise, judgment, reliability, and ability to work with others.* 0/300

2. Commitment to Health Equity and Social Justice*

{"key":"reference_letter","type":"textarea","label":"Please describe the candidate\u2019s understanding of and commitment to health equity, fairness, social justice, or social change. Where possible, please provide specific examples from their work or community engagement.","name":"referee_question_2","required":true}

Please describe the candidate’s understanding of and commitment to health equity, fairness, social justice, or social change. Where possible, please provide specific examples from their work or community engagement.* 0/300

3. Leadership Qualities and Potential*

{"key":"reference_letter","type":"textarea","label":"Please provide your perspective on the candidate\u2019s leadership qualities and potential. You may comment on their ability to lead change, work across differences, collaborate with others, communicate effectively, and influence systems or communities.","name":"referee_question_3","required":true}

Please provide your perspective on the candidate’s leadership qualities and potential. You may comment on their ability to lead change, work across differences, collaborate with others, communicate effectively, and influence systems or communities.* 0/300

4. Suitability for the Fellowship*

{"key":"reference_letter","type":"textarea","label":"Why do you believe this candidate is a good fit for the Equity Initiative Fellowship Program at this stage of their leadership journey?","name":"referee_question_4","required":true}

Why do you believe this candidate is a good fit for the Equity Initiative Fellowship Program at this stage of their leadership journey?* 0/200

The referee may upload a PDF, DOC, or DOCX file with the same content as above. Please note that the required textboxes must still be completed in order to 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