Welcome to the QSLA 2023 Scholar Nomination Questionnaire!

Thank you all for your interest in the Quality and Safety Leadership Academy (QSLA)! The questionnaire below is comprised of four sections requesting various pieces of information pertinent to your attendance and potential acceptance to the program. If at any time you have questions about the questions below, please do not hesitate to reach out to the QSLA Support Team at usn.ncr.bumedfchva.mbx.qualityand-safetyleadershipacademy@health.mil.

Final Scholars for QSLA should be notified of their selection prior to the Thanksgiving holiday.

Applicant Information

1. Please provide the demographic information requested below. 1. Please provide the demographic information requested below.
2. Please provide the contact information requested below. Due to the health.mil email transition concerns, we encourage you to list a secondary email in the box provided. 2. Please provide the contact information requested below. Due to the health.mil email transition concerns, we encourage you to list a secondary email in the box provided.
3. Please provide a brief description of your role within your command and any secondary responsibilities you feel would be relevant to your application.

Statement of Interest

4. In 200 words or less, please describe why you are interested in QSLA, what you hope to gain from the program, and how you plan to use the HRO skills and knowledge acquired during the program in your current and/or future role.

Participant Availability and Commitment

5. Two QSLA Cohorts are being planned to occur throughout CY 2023. Both Cohorts will feature an in-person Kick-Off (approximately one week) and subsequent Virtual Classrooms (~20 to 25 hours over the course of three months). From the following options, please indicate which of the Cohort options you would be able to attend*. Final Scholars will only be selected for one Cohort. If you cannot attend one of the Cohort options due to a prior scheduling commitment, please specify your schedule conflict for that timeframe. *DISCLAIMER: Please note that travel funding to attend QSLA will be determined once Scholars have been selected, and may be required to be Command-funded. Additional guidance on travel booking and Kick-Off logistics will be provided to confirmed Scholars. Any additional concerns pertaining to the in-person Kick-Off may be referred to the QSLA Support Team Mailbox. 5. Two QSLA Cohorts are being planned to occur throughout CY 2023. Both Cohorts will feature an in-person Kick-Off (approximately one week) and subsequent Virtual Classrooms (~20 to 25 hours over the course of three months).

From the following options, please indicate which of the Cohort options you would be able to attend*. Final Scholars will only be selected for one Cohort. If you cannot attend one of the Cohort options due to a prior scheduling commitment, please specify your schedule conflict for that timeframe.

*DISCLAIMER: Please note that travel funding to attend QSLA will be determined once Scholars have been selected, and may be required to be Command-funded. Additional guidance on travel booking and Kick-Off logistics will be provided to confirmed Scholars. Any additional concerns pertaining to the in-person Kick-Off may be referred to the QSLA Support Team Mailbox.
6. Please indicate if you are anticipating a permanent change of station (PCS) during the QSLA timeframe; if so, please note your anticipated Command and Title. 6. Please indicate if you are anticipating a permanent change of station (PCS) during the QSLA timeframe; if so, please note your anticipated Command and Title.
7. I have informed my Chain of Command leadership of my application and intent to participate in QSLA, and confirm their support for my participation. 7. I have informed my Chain of Command leadership of my application and intent to participate in QSLA, and confirm their support for my participation.
8. If selected, I commit to attending 100% of the week-long in-person Kick-Off and at least 80% of the Virtual Classroom sessions (~20-25hrs over the course of three months) following the program Kick-Off. 8. If selected, I commit to attending 100% of the week-long in-person Kick-Off and at least 80% of the Virtual Classroom sessions (~20-25hrs over the course of three months) following the program Kick-Off.

Program Awareness

9. How did you hear about QSLA? Please note how you became familiar with the program below.
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