Just Culture Scholarship Application

Applicants must be submitted online and supporting documents must be emailed by September 28, 2023:

Submit an online application
Email containing:
1. Resumes (2 pages maximum) for each team member
2. Team letter of intent (1,000 words maximum) outlining:
  - Team's interest in the scholarship
  - Description of the organization's current culture
  - Current infrastructure, organizational goals, and leadership support in place to support Just Culture implementation
  - Evidence of interdisciplinary collaboration
  - Ability of the designated team to manage organizational change and disseminate learning
3. Just Culture Leadership Declaration signed by your organization's executive leader
4. Just Culture Team Member Declaration individually signed by each team member

You will receive an email confirmation after submitting your application. Supporting documents must be emailed as a reply to your confirmation.

All fields with * are required

Team Member #1 (will receive email confirmation)

* First Name:

* Last Name:

* Job Title:

* Phone:

* Email:

* Confirm Email:

Team Member #2

* First Name:

* Last Name:

* Job Title:

* Phone:

* Email:

Team Member #3

* First Name:

* Last Name:

* Job Title:

* Phone:

* Email:

Organization Information

* Organization Name:

* Country:

* Street:

* City:

* State:

* Zip:

Related

Scholarship Information