Managing Healthcare Management Programme - Application Form - Strathmore University Business School

PLEASE COMPLETE IN BLOCK CAPITALS

Family Name:*

Other Names:*

Cell Phone Number:

Email address:

Date of Birth:*

Country of Residence:*

Nationality:*

Industry*

Name of Organization you are currently working at:*

Designation in the Organization:*

PROFESSIONAL DEVELOPMENT

Have you attended any formal training/professional program on Managing a Healthcare Business?*

Yes
No

Are you responsible for professional development in your organization? (training, capacity building etc)?*

Yes
No

Sub-sector in which your healthcare business is operating.*

If Others Kindly Specify:*

Your Healthcare Business Relationship*

Investor in the Business
Owner and Manager running the Business
Manager in the Business but not owner
Employee in the business
Employee with a healthcare business as a side hustle
Employee looking to start a healthcare business
Not employed and looking to start a healthcare business

How many years have you spent in your role in Q2 above?*

If you are the owner or investor in the healthcare business, how many years have you had the business?*

How many employees are in the Healthcare Business?*

Where is your Healthcare Business located?*

Rural setting
Rural/Urban setting
Urban setting
Low income setting
Mid income setting
High income setting

What mode of payment is used in your Healthcare Business?*

Cash - Direct/Bank Transfer
Mpesa/Airtel Money
Visa/Mastercard/Other Card Payments
Insurance - private
NHIF

What is the dominant mode of payment used in your healthcare business?*

Cash - Direct/Bank Transfer
Mpesa/Airtel Money
Visa/Mastercard/Other Card Payments
Insurance - private
NHIF

What percentage does the dominant mode of payment take?*

As a Healthcare Business, which operations do you think need urgent attention?*

IT
Finance and Accounts
Human Resources
Procurement
Stocks Management
Customer service
Others, please specify

If Others please Specify:*

Does your Healthcare Business Have the following clearly stated?

Mission*

Yes
No

Vision*

Yes
No

Core Values*

Yes
No

Code of Conduct*

Yes
No

Service Charter*

Yes
No

What are the 3 things you think are stopping your healthcare business from growing?*

HEALTHCARE ENTREPRENEUR RELATED

How many years have you been in business?*

What are the 3 things you hope the MHB Program will help you address?*

Which MHB Program Option would you be interested in attending?*

Any other information you would like to clarify/inquire about?*

CANCELLATION POLICY

All cancellations must be made in writing to the Program Manager. Cancellations made less than 14 days to thecommencement of the seminar, are subject to a penalty of 25% of total program fee.

I agree to the terms of the cancellation policy as detailed above.

Date:*

Would you like to receive our weekly newsletter (At a Glance)?*

Yes
No

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Managing Healthcare Management Programme – Application Form

Managing Healthcare Business Programme - Application Form

PLEASE COMPLETE IN BLOCK CAPITALS

PROFESSIONAL DEVELOPMENT

Does your Healthcare Business Have the following clearly stated?

HEALTHCARE ENTREPRENEUR RELATED

CANCELLATION POLICY

A Culture of Ethics & Learning

SBS PARTNERS

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