Application for Admission to the Leadership and Management Program

2011/2012

Please complete the Application for Admission Form.
You can submit your application one of two ways:

1. Print the application form and mail it with your payment to the address below.

2. Complete the on-line form and click on 'Send Results'. This information will be sent by e-mail to the Leadership Management administrator.

You will not be fully registered for the program until we have received your payment.
See below for payment plan options.

Full Name
Home Address
City
Province
Postal Code
Phone
Email
Date of Birth
S.I.N.
Current Employer
Position
Work Address
Work City
Work Province
Work Postal Code
Work Phone

Basic Professional Education:

I learned about the Leadership and Management Program through:

I have previously been registered as a student at McMaster University:
Yes Student #

Tuition Schedule
Application Fee: $100.00 This fee must accompany all applications for Program courses listed below. (Non Refundable Fee. Payable one-time only)

Which course(s) would you like to take?

(N4B06) Leadership and Management (6 units of Nursing credit)
(HS4E06) Leadership and Management (6 units of Health Science credit)

     Tuition: Please select one of the following payment plans
      Plan 1 - Payment of $1,280.00 (cheque or credit card)
      Plan 2 - Payment of $1,290.00 in two installments of $645.00 (post dated cheques or credit card)

(N4I03) Interprofessional Teams (3 units of Nursing credit)
(HS4I03) Interprofessional Teams (3 units of Health Science credit)

     Tuition: Please select one of the following payment plans
      Plan 1 Payment of $805.00 must accompany application form (cheque or credit card)
      Plan 2 Payment of $815.00 in two instalments of $407.50 (post dated cheques or credit card)

(N4Z03) Conflict Management (3 units of Nursing credit)
(HS4Z03) Conflict Managemnt (3 units of Health Science credit)

     Tuition: Please select one of the following payment plans
      Plan 1 - Payment of $805.00 (cheque or credit card)
      Plan 2 - Payment of $815.00 in two instalments of $407.50 (post dated cheques or credit card)

(N4HH3) Quality Management (3 units of Nursing credit)
(HS4HH3) Quality Management (3 units of Health Science credit)

     Tuition: Please select one of the following payment plans
      Plan 1 Payment of $805.00 must accompany application form (cheque or credit card)
      Plan 2 Payment of $815.00 in two instalments of $407.50 (post dated cheques or credit card)

(N4DD6) Advanced Leadership and Management (6 units of Nursing credit)
(HS4DD6) Advanced Leadership and Managemnt (6 units of Health Science credit)

     Tuition: Please select one of the following payment plans
      Plan 1 - Payment of $1,380.00 (cheque or credit card)
      Plan 2 - Payment of $1,390.00 in two instalments of $695.00 (post dated cheques or credit card)

(N4FF3) Integrative Leadership Project (3 units of Nursing credit)
(HS4FF3) Integrative Leadership Project (3 units of Health Science credit)

     Tuition: Please select one of the following payment plans
      Plan 1 - Payment of $910.00 (cheque or credit card)
      Plan 2 - Payment of $920.00 in two instalments of $460.00 (post dated cheques or credit card)

**Note: N4B06 and HS4E06 are the same course. N4B06 is for registered nurses;
HS4E06 is for health care professionals other than nurses.**

Which session would you like to take your course(s) in?

Fall 2011
Winter 2012
Spring 2012

Payment (Please complete, print and mail or fax form to address below, contact program office with payment information)

You may pay by cheque or select one of the following:

Credit Card:

Cardholder's Name:

Card #:

Expiry Date:

Mail to:

Leadership and Management Program
McMaster University
1280 Main Street West, HSC Rm 2J41
Hamilton, ON L8S 4K1

Fax to: (905) 529 - 3673

If you have any comments or questions please contact the Leadership and Management Program
Office:

Program Office:
Barbara Tatalovic, Administrator btatalov@mcmaster.ca
Phone: (905) 525 - 9140 ext. 22409
Nancy Morris, Administrative Assistant
Phone: (905) 525 - 9140 ext. 22319
Fax: (905) 529 - 3673
Program Email: mgtprog@mcmaster.ca

Applicants may send their application directly to the Leadership and Management Program email or print to fax or mail.