NRHA's Rural Hospital HR Certification Program Enrollment - Informational Form

Complete the informational form below to enroll in the HR Cohort.

First Name

Last Name

Job Title

Facility

City

State

Work Phone

Mobile Phone

How many years have you worked in your current position?

How many years have you worked at a rural hospital?

How many years have you worked in rural health?

Why do you want to participate in this program?

Where do you want to be 5 years from now?

Please list any other professional associations you are a member of:

What is the best way to contact you?

By selecting the option below I am verifying that I am a current HR executive/leader in a rural hospital.

*Submission of a signed letter of support is also required for enrollment. This can be submitted on the previous page.