Application Form - Cardio AI Global Leadership Program

1 Personal Information

Please provide your basic contact information.

First Name * Please enter your first name

Last Name * Please enter your last name

Email Address * Please enter a valid email address

Phone Number * Please enter your phone number

LinkedIn Profile URL

Country * Please select your country

City * Please enter your city

2 Professional Background

Tell us about your current role and organization.

Current Organization * Please enter your organization name

Job Title * Please enter your job title

Years of Professional Experience * Please select your experience level

Primary Role * Please select your primary role

Brief Description of Current Responsibilities *

0 / 500 characters

Please describe your current responsibilities

3 Educational Background

Share your academic qualifications.

Highest Degree Earned * Please select your highest degree

Field of Study * Please enter your field of study

University/Institution * Please enter your university

Additional Certifications or Training

0 / 300 characters

4 Application Essays

Please answer the following three questions. Each response should be approximately 500 words.

📝 Essay Guidelines:

Target length: 500 words per essay
Be specific and provide concrete examples
Demonstrate your leadership experience and vision
Show your understanding of cardiovascular AI opportunities

Essay 1: Leadership & Innovation *

Describe a specific healthcare innovation or transformation initiative you have led. What was the challenge, your approach, and the outcomes? What did you learn about leading change in healthcare?

0 / 4000 characters (~500 words)

Please complete Essay 1

Essay 2: AI Vision & Strategy *

How do you envision AI transforming cardiovascular care over the next 5-10 years? What specific opportunities or challenges do you see in your organization or region? How do you plan to contribute to this transformation?

0 / 4000 characters (~500 words)

Please complete Essay 2

Essay 3: Program Goals & Impact *

Why are you applying to the Cardio AI Global Leadership Program now? What specific skills, knowledge, or network do you hope to gain? How will you apply what you learn to create impact in your organization or community?

0 / 4000 characters (~500 words)

Please complete Essay 3

5 Supporting Documents

Please upload your resume/CV and optional video introduction.

Resume/CV *

Requirements: PDF format, maximum 3 pages, file size under 5MB

📄 Click to upload Resume/CV (PDF, max 3 pages)

Please upload your resume/CV

Video Introduction (Optional)

Optional but recommended: 3-minute video introduction. Upload to YouTube or Vimeo (unlisted) and provide the link.

6 Professional References

Please provide contact information for two professional references who can speak to your leadership capabilities and potential.

Reference Guidelines:

References should be professional contacts (supervisors, colleagues, or collaborators)
Not family members or personal friends
References will be contacted after initial application review

Reference 1

Full Name * Please enter reference name

Title/Position * Please enter reference title

Organization * Please enter organization

Email * Please enter valid email

Relationship to You * Please describe your relationship

Reference 2

Full Name * Please enter reference name

Title/Position * Please enter reference title

Organization * Please enter organization

Email * Please enter valid email

Relationship to You * Please describe your relationship

7 Program Details & Financial Information

Please indicate your payment preference and scholarship interest.

How did you hear about the program? * Please select a referral source

Preferred Payment Option *

Full Payment (5% discount)
Pay $36,100 (save $1,900) 3 Installment Payments
3 payments of $12,667 each Organizational Payment
Direct invoicing to organization

Please select a payment option

Are you interested in applying for a scholarship?

Diversity Scholarship ($5,000)
For underrepresented groups in healthcare AI Early Application Scholarship ($3,000)
Application submitted by January 15, 2026

Additional Comments or Questions

0 / 500 characters

8 Acknowledgment & Agreement

Please review and agree to the following statements.

I certify that all information provided in this application is true, accurate, and complete to the best of my knowledge. * I understand that my application will be reviewed by the admissions committee and that acceptance is not guaranteed. * I commit to full participation in the program if accepted, including online sessions and two in-person immersions in Boston. * I agree to the program's $38,000 tuition and understand the payment options and refund policy. *

Electronic Signature * Please enter your full name as signature

Date * Please enter today's date

🫀 Application Form

1 Personal Information

2 Professional Background

3 Educational Background

4 Application Essays

5 Supporting Documents

6 Professional References

Reference 1

Reference 2

7 Program Details & Financial Information

8 Acknowledgment & Agreement

Application Submitted!