National Public Health Leadership Institute

PHLI Application

Items marked with an asterisk (*) are required.
Personal information:
 
* First name Middle initial * Last name
 
* Job title * Organization/agency
 
* Work address Work address (line 2)
 
* City * State Country * Zip code
 
* Work number Extension
(format: nnn-nnn-nnnn)
 
Work fax number
(format: nnn-nnn-nnnn)
 
* E-mail address at work
E-mail address at home
Academic degree(s) earned:
 
* Degree * University
 
Degree University
 
Degree University
Job information:
 
* Organizational sector
 
* Description of your organization/agency
 
* Number of FTEs you manage
 
* Total number of FTEs in your entire organization/agency
 
* Total budget under your direct or indirect control, including all units and subunits that ultimately report to you
 
* Length of time in current position (in years)
 
* Length of time working in population health (years)
 
Focus area(s) of your work in public health (e.g., rural health, disparities, chronic disease)
 
* Previous leadership institutes and year completed
 
* Where you heard about the National Public Health Leadership Institute
Alumni
Supervisor
Colleague
Mail
E-mail
Ad
Professional association (please name) 
Other (please specify) 
Person you report to:
 
* Name Title
 
E-mail Work phone number
(format: nnn-nnn-nnnn)
 
* Do you have this person's support to attend PHLI?
Yes      No
Learning partner: (optional)
 
Name E-mail
Essays:

The best way to do this step is to compose your essays in a word processing program, copy, and then paste them into the text boxes in the online application. Be sure to keep a copy of your essays. Each essay has a word limit of 300 words.
 
 
* Please describe (in 300 words or less) why you are interested in attending the PHLI. What personal and professional goals do you hope to achieve as a scholar? Focus on system change.
 
* We would like to know about your network (for instance partners, associations, or professional groups). What are the key parts of your professional network? What leadership roles do you play, or aspire to, within your network?
 
* Describe one or two national public health issues you are currently engaged in as a public health leader. How are you involved now, and what is your vision for the future?
Demographics:
 
Date of birth (format: mm/dd/yyyy)
 
Gender
Male      Female
 
Race or ethnic origin
Admission to School of Public Health programs is without regard to race, sex, national origin, color, religion, handicap, age, veteran's status, or sexual orientation.
Letters:
 
Please submit via email two letters of recommendation. One should come from a person you report to. A second should come from someone outside your organization who knows your work and can judge your potential.
Recommendation letters should focus on your past involvement and your future potential as a leader of system change. Of special interest are the following: your potential as a future leader; your experience and sphere of influence as a leader; the depth and breadth of your network; and your commitment to leadership development.
Please email recommendation letters to phli@unc.edu.
 
 
A program of the North Carolina Institute for Public Health
National Public Health Leadership Institute
Mailing Address: CB #8165 | Chapel Hill, NC 27599-8165
Shipping Address: 400 Roberson St. | Carrboro, NC 27510
Fax: 919-843-5563 | Email: phli@unc.edu
NC Institute for Public Health | School of Public Health | University of North Carolina at Chapel Hill