Kentucky Public Health Leadership Institute

Personal Growth for Leadership Excellence: Becoming a Reflective Leader

360 Degree Feedback

Social Styles Self-Assessment

Emotional Intelligence and Personal Mastery

Individual Development Plan

Teamwork

Individual Development Plan (pdf format)

Futures Thinking and Creating a Shared Vision

Vision, Values, Mission

10 Essential Public Health Services

Core Public Health Functions

Systems Thinking

Healthy People 2020

Creating a Shared Vision

How to Become An Effective Agent of Change

Learning Organizations

Creativity

The Tipping Point

Getting Results- Team Building and Collaboration

Conflict Resolution and Negotiation

Mental Models and Personal Mastery

Communication

National Performance Standards and the CDC National Goals

Collaborative Leadership

Health Needs Assessments

Cultural Competency

Social Marketing

Team Building and Partnerships

Political, Communication and Advocacy Skills: Key to Influencing Others

Public Health Ethics

Public Health Policy

Leadership

Decision Making

Development

Change Strategies Within Bureaucratic Systems

Preparedness

Public Health Preparedness

Risk Communications

The Prepared Leader

Strategic and Tactical Planning

Leadership in Times of Crisis and Change

Developing Others

Coaching and Mentoring

Change Master Project

Applications for the 2012 - 2013 Kentucky Public Health Leadership Institute scholar class will be accepted now through March 13, 2012.

To Apply

Complete the on-line application

Submit your resume by fax, e-mail or mail, and

Submit your letter of support from your management by:
MAIL:111 Washington Avenue, Room 212, Lexington, KY 40536-0003,
FAX: 859-257-3748 or
EMAIL: Erin Louis

Selection Criteria

The selection committee will be looking for individuals with experience and educational backgrounds in Public Health. The desire to facilitate change and demonstrated ability to get things done will be weighed heavily. Application requires the support and recommendation of your management. Those selected to be scholars for the year must be able to devote 2 to 3 hours weekly to the Institute and have accessibility to a computer and the internet. The selection committee will attempt to achieve a heterogeneous mix of participants from all areas of the state and various public health settings.

Certificate Program

Participants who complete the year-long KPHLI experience will be awarded a Certificate in Public Health Leadership from the Kentucky College of Public Health.

3 - 6 hours of course credit will be available for scholars. Application of these hours to degree programs will be at the discretion of the learning institution/university and the individual program. Individuals wishing to receive college credit for KPHLI efforts need to make application to the undergraduate or graduate program separately and pay tuition for those credit hours.

CEU's will also be awarded for courses and seminars completed through KPHLI. It is estimated that 30-60 CEU's will be available through the program.

KPHLI will begin accepting applications January 1, 2012 The application deadline is March 13, 2012.

Thanks for taking the time to apply! Contact Erin Louis if you have any questions, phone: 859-218-2061, fax: 859-257-3748.

Use this form to apply for the Kentucky Public Health Leadership Institute. Complete all items on the form and submit electronically by clicking the "Submit" button at the bottom of the page. Please answer each question completely. Incomplete applications will disqualify the applicant.

Please click submit only once. You should receive a confirmation that the application was successfully submitted. Occasionally the application may time-out and erase the fields upon submission. If this occurs, the completed application will be sent to Erin Louis. You will not have to fill it out again.

NOTE: If you are accessing the site using your bookmark, please refresh your browser before filling in the application. Thank you.

Section I
First Name: Middle: Last Name:
Degrees/Certifications/Licenses:
Organization Name:
Business Address 1:
Business Address 2:
City:
State:
Postal Code:
Business Phone : (Area code + number)
Business Fax: (Area code + number)
Email:
I am Applying as a	Local Health Professional State Health Professional Public Health Community partner (eg. university, AHEC, county extension, health agencies)
Gender:	Male Female
Date of Birth:(Month/Day/Year)
Special Needs (list if any):
Ethnicity	White African American Native American or Eskimo Hispanic (Mexican American, Puerto Rican, Other Hispanic) Asian or Pacific Islander Other
Other:
Section II
A. Resume/ Curriculum Vitae Instruction: Please fax or mail or e-mail your resume or curriculum vitae (CV) to Erin Louis Assistant Director, Kentucky Public Health Leadership Institute Fax: 859-257-3748 Academic Degrees (Certificates/Licenses) Job Position titles, supervisor, dates of position, organization, responsibilities, and achievements Leadership in Professional Organizations Special Honors, Awards, Fellowships, or Scholarship Award Personal Interests (optional) B. Applicant Organization/Employer Background Information
1. Agency/Organization Name (full name of your organization, i.e. Department of Health and Human Resources, Public Health,Division of Environmental Health, Lead Poison Program):
2. Type of Organization:	State Region District Single County City Other
Other:
3. Size of Population served by the organization/department:	Less than 5,000 5,000 - 9,000 10,000 - 49,999 50,000 - 99,999 100,000 - 249,999 250,000 - 500,000 Over 500,000
4. Type of area served by the organization/department: (Check all that apply)	Rural Urban Suburban Other Special Population
Other:
Special Population (Describe):
5. Description of your position responsibilities and activities: (Check all that apply)	Program Manager Consulting Assessing Staff management/Supervision Information Technology Inspecting Planning Engineering Investigating Budgeting Designing Data Analysis Direct Care Implementing Communicating Education Programs Negotiating Team Developing Research Controlling Community Organizing Evaluation Counselling Other
Other:
Your Title/Position:
Is your position:	Full time Part time
If part time, how many hours do you work/time period?
Number of years at current position:
Number of months at current position:
Number of years of local/state public health experience in Kentucky:
Number of Months of local/state public health experience in Kentucky:
Section III - Essay Question A. Personal Statement
Please submit a personal statement of less that 200 words describing what you hope to gain through participation in the Kentucky Public Health Leadership Institute. Include a discussion of benefits you anticipate for your community, your agency, and yourself as well as how the leadership development program will lead to greater effectiveness in helping your agency to carry out the core public health functions of needs assessment, assurance,a nd policy development. Please type your statement in the space below:
Section IV: Scholar Rsponsibilitits and Commitments A. As an applicant for the Kentucky Public Health Leadership Institute program, I understand this involves a year-long commitment. I am willing and able to make the following commitments if invited to be a scholar in the Institute: To devote the time necessary to fully participate in the Insitute's activities. (approx. 3 hres/week) To attend and be an active contributor during the Institutes's leadership summits. To prepare for the Institute's programs by reading materials sent in advance. To participate actively in schedules programs or sessions conducted using the following technolgies: To plan and implement a Change Master Project during the program year. If you currently have an idea for a Change Master Project, please include your idea in the space below, and if you are applying as a team please indicate team members names here as well. If requested, to participate in the future as a mentor or coach for scholars in subsequent Institutes. To have regular access to a computer and Internet access, and utilize these to complete the scholar requirements, which include computer conferencing and internet use. Refer to Item 5. If you currently have an idea please enter it here.
I agree to these commitments
B. Management Support: In the space below, please provide the name, address, phone number, and fax for your immediate supervisor.
Supervisor's Name:
Title/Credentials:
Billing Address:
City:
State:
Zip:( +4 if know)
Phone:
Fax:
Email:
C. Letter of Support/Recommendation Please fax or email a letter of support and recommendationf rom the Public Health Department Director indicating financial and managerial support of your participation in the KPHLI. If you are a Public Health Department Director, a latter from your Board Chair is required. State Health Employees should request a letter from the Commissioner of Chief. Community Partners need a letter from their manager or board chair. Ask your supporter to fax, mail or email a letter to the KPHLI office. Checklist: Completed all questions (including the essay question( in the application? Faxed or mailed your current resume or curriculum vitae (CV)? Obtained your management support and faxed letter? Completed the commitment agreement box? Cynthia Lamberth Director, Kentucky Public Health Leadership Institute College of Public Health 111 Washington Avenue, Rm 212 Lexington, Ky 40536-0003 Erin Louis Assistant Director, Kentucky Public Health Leadership Institute College of Public Health 111 Washington Avenue, Rm 212 Lexington, Ky 40536-0003 Remember! The deadline for application submission is March 13, 2012 at 5pm. For more information, email Erin Louis. This project is funded by the Kentucky State Department for Public Health.