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2012 Public Health Leadership Programme
 
Full name* Job title*
Preferred name Company*
Ethnicity*



 
Discipline *

Other :  
 
Address (postal) Contact
Street* Telephone*
Suburb* Mobile
City* Fax
    Email*
 
       


Please note the dates for the programme.
You must be available for all six days of the programme.

1st date preference
2nd date preference
 
Describe the leadership component of your current position
 
  Number of years in current position
  Number of years in public health
 
Public health qualifications Other qualifications
 
I have my manager's support to attend this programme, including resources to pay for accommodation, meals and travel, and time off to attend the 6 day programme

Manager's Email
 
There will be a small number of scholarships available to assist with accommodation, meals and travel costs.
Please indicate whether you would like to be considered for a scholarship.


What are the qualities that make you a good leader? (100 words maximum)

In your professional life, what are the two to three accomplishments you are most proud of? (200 words maximum)

In what ways do you demonstrate commitment to the core values of public health? (100 words maximum)

What are the critical leadership challenges in public health? (200 words maximum)

What would you want to accomplish through participating in this leadership programme? (200 words maximum)