About IU Health. IU Health s Mission and Vision

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1 Thank you for your interest in the Administrative Fellowship program at IU Health. As defined in our mission statement, we are dedicated to educating and preparing healthcare professionals to lead our industry into the future. This fellowship is a two-year experience where aspiring healthcare leaders will work alongside our senior executives and physician leadership to gain an understanding of IU Health operations and strategic priorities. About IU Health Indiana University Health (IU Health) is the largest health system in Indiana and among the top ten largest single state nonprofit health systems in the U.S. In addition to its 18 hospitals (a mix of urban, suburban and rural), IU Health offers a comprehensive breadth of services and employed physician groups both primary care and specialty care. The IU Health Physicians group employs more than 1,000 physicians in the metropolitan Indianapolis area. A unique partnership with Indiana University School of Medicine (IUSM), one of the nation s leading medical schools, gives patients access to innovative treatments and therapies. IU Health is an independent, nonprofit health system comprised of hospitals, physicians and allied services dedicated to providing preeminent care throughout Indiana, the nation and the world. As Indiana s most comprehensive healthcare system, IU Health is dedicated to providing preeminent care throughout Indiana and beyond. IU Health includes three major hospitals in Indianapolis IU Health Methodist Hospital, IU Health University Hospital and Riley Hospital for Children which serve as the academic health center (AHC). Our regional and statewide facilities align with the AHC to provide seamless, high quality patient care. IU Health s Mission and Vision To employees of IU Health, the mission is central to how they provide care and service to their patients. IU Health s mission is to improve the health of its patients and community through innovation and excellence in care, education, research and service. The vision that guides IU Health is: "IU Health strives to be a preeminent leader in clinical care, education, research and service. Our excellence is measured by objective evidence and established best practices. Exemplary levels of respect and dignity are given to patients and their families, while professionalism and collegiality mark relationships between employees and physicians. IU Health continues to focus on innovation and excellence through collaboration among its partner hospitals and its affiliation with Indiana University School of Medicine." For more information, please visit

2 Application Process Candidates for the Fellowship program must be either in the process of completing or have a Master s Degree from a CAHME, AACSB and/or ACBSP accredited graduate program (i.e., MHA, MBA, MPH). Successful applicants will be able to display leadership skills and experience, relevant work experience, and strong academic performance. Fellows receive a competitive salary and benefits package, along with a stipend for relocation expenses. Important Dates: Application Packet Due Date: September 15, 2014 Phone Interviews: October 1 15, 2014 On-Site / Final Round Interviews: October 16 November 7, 2014 Final Selection: Late November / Early December Start Date: July 6, 2015 Application Packet Checklist: 1. Personal Information Sheet 2. Resume 3. One page personal statement a. Please describe career goals and how the Fellowship will help achieve those goals. b. Please describe why IU Health is the desired place to complete your Fellowship experience. 4. Official transcripts of Graduate and Undergraduate academic records 5. Three (3) letters of recommendation (using form provided) from: a. One (1) from an academic professor b. One (1) from the graduate program director c. One (1) from a past or present employer Please send Application Packet to: Administrative Fellowship Coordinator IU Health Fairbanks Hall 340 W 10 th St, Suite 2200 Indianapolis, IN Questions can be sent to adminfellowship@iuhealth.org.

3 Personal Information Sheet Please type responses using the fields provided. Name: Address: City, State, Zip: Phone: Address: I understand that E-Verify will be used to verify my eligibility to work in the U.S. (Please place X in box) Indiana University Health participates in E-Verify. Click below to view notices: E-Verify Participation Notice E-Verify Right to Work English Spanish English Spanish Have you ever been employed by IU Health or any of its affiliates or entities in any capacity? Y N If so, where/when: Have you ever received a bonus, loan or scholarship of any type from IU Health? Y N If yes, when and in what amount? Have you ever been convicted of a felony or misdemeanor that has not been expunged (erased or stricken) by court? Y N If yes, explain. (Conviction means you were found guilty by a judge, jury, "no contest," or guilty plea in court. A conviction may have taken place even if you did not pay a fine or spend any time in jail or prison. A conviction will not automatically disqualify you from employment). Do you have any unresolved criminal charges? (that is, criminal charges that have not yet been resolved though a plea, court verdict, deferred adjudication or dropping of the charge). Y N If yes, explain fully. Please note that certain unresolved criminal charges may prevent further processing of the application, until the matter has been resolved. Have you ever been disqualified, excluded from, or denied participation in any federal or state healthcare program (e.g., Medicare, Medicaid, Dep't of Veterans Affairs), or are you aware of any ongoing process that may result in your disqualification, exclusion, or denial of participation in any federal or state healthcare program? Y N Are you now, or have you ever been, in default on any health education loan or scholarship obligation, or have you failed to enter into an agreement to repay Health Education Assistance loans? Y N

4 Read the following carefully before signing. It is the policy of IU Health that equal employment opportunities be available to all without regard to race, color, gender, sexual orientation, religion, national origin, age, disability, or veteran status. The receipt of this application does not imply that the applicant will be employed. Each question should be answered in a complete and accurate manner since no action will be taken on this application unless all questions are completed. I certify the information in this application (and in any accompanying documents) is true and complete in all respects. If hired, I understand my omission, false or misleading information in this application, discovered any time during the employment process or after employment is initiated, may lead to my termination. I understand an employment offer with IU Health is contingent upon verification of education, previous employment history and a criminal and driving record, if applicable, background investigation. My signature on this application authorizes IU Health to request written or verbal verification as needed. I understand that upon acceptance of an employment offer, IU Health will require a health assessment which may include, but is not limited to, a health history, immunization update, drug screening test and TB test. I hereby consent to such examinations and understand that my employment is contingent upon successful completion of the pre-placement health assessment. If accepted for employment, I understand I must provide documents which prove I may legally work in the U.S.A. I agree to comply with established rules, policies and procedures of IU Health. This includes, but is not limited to, those which relate to confidentiality, employment and the Center for Disease and Prevention Control universal precautions. I understand any employment with IU Health will be employment at will; my employment can be terminated at any time, with or without cause and with or without notice at the option of IU Health or myself. I understand that the terms and conditions of employment may be changed at any time without notice by IU Health IU Health is an equal opportunity employer, supporting a drug-free, smoke-free workplace. IU Health is a Magnet designated hospital system. Signature: Date:

5 This one-page submission must address: Personal Statement Please type response using the field provided. Career goals and how the Fellowship will help achieve those goals. Why IU Health is the desired place to complete your Fellowship experience.

6 Reference Form Top section to be completed by Applicant, then provided to Reference with an envelope marked Recommendation : Name of Applicant: Name of Reference: Title of Reference: Business Address: Reference Phone Number: Reference Address: I waive any rights I may have to this recommendation form when completed. I understand that this confidential recommendation is to be used only in consideration of my application to the program. Signature: Date: Instructions to Reference: 1. Complete the Competency Assessment (by placing an X in the box below). 2. Please respond to Questions 1-4 below (on a separate piece of paper). 3. Place all reference information in envelope provided by Applicant. 4. Sign the envelope across the sealed flap and return to Applicant for submission with his/her other application materials. COMPETENCY ASSESSMENT Outstanding Above Average Average Below Average Not Observed Maturity Creativity Leadership Potential Written Communication Verbal Communication Interpersonal Skills Initiative Collaboration Adaptability Overall Rating 1. How long and in what capacity have you known the Applicant? 2. What are the Applicant s strengths & talents that will allow them to be successful in a Fellowship experience? 3. What are the Applicant s weaknesses or areas for improvement? 4. Any additional comments that should be considered when reviewing the Applicant for a career in healthcare administration. Signature Date Applicant should NOT open the Recommendation envelope before mailing to IU Health with a complete application packet.