Application

Name*
First Last
Title*
Organization*
Role*
Years of Experience (in advanced practice leadership)*
APPex Member Since*
Sponsor Name [APPex Board Member or APPex Fellow]*
Letter of Recommendation - Sponsor*
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Performance Improvement Exemplar #1*
Performance Improvement Exemplar #2*
Performance Improvement Exemplar #3*
Contributions to Advanced Practice Administration*
Letter of Recommendation - Administrator #1*
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Letter of Recommendation - Administrator #2*
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Curriculum Vitae (CV)*
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Email
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