Participant Application

Applications will be reviewed for experience, demonstrated leadership potential, understanding of the CalHHS core competencies, and your department’s present and future issues and pressures, and how you as a leader, have and will address these challenges. Please review all of the materials for the LDA before you apply.

NOTE: A complete application consists of two parts: your online application AND your sponsor’s endorsement. It is YOUR responsibility to ensure that your sponsor completes the endorsement by the due date. Failure to have both parts submitted by the due date will result in your application being considered incomplete and late. There is no guarantee that late applications will be reviewed by the LDA Advisory Committee for this cohort.

Cohort Information

Please review the dates below; if you are accepted into the LDA you must be available to participate in the Participant Kickoff and Sessions 1-9.

Chief Deputy Director Concurrence

All Chief Deputy Directors will receive a list of all LDA applicants for information and possible prioritization. The CalHHS Agency will secure that concurrence prior to the review and selection of the cohort.

Applicant

First Name: Last Name: Email: Address: Address 2: City: State: Zip Code: Phone Number: Additional Phone: Preferred First and Last Name:

(for name tags & class rosters)

Operational Title: Department: Division: Office/Unit: Civil Service Classification: Attended other supervisor/leadership trainings:

Have you attended any other supervisor or leadership training programs
(e.g., CHHS Supervisors’ Academy, CCE Leadership for the Government Executive, CIO Academy, etc.)?

Yes - Please Explain:
No
Have you previously applied:

Have you previously applied to the CHHS Leadership Development Academy?

Yes
No
Reasonable accommodations:

Do you need reasonable accommodations to attend the CHHS Leadership Development Academy?

Yes - Please Explain:
No

Applicant Demographic Information

Gender: Male
Female
Sacramento State University Alum:

Sacramento State University Alum?
This question is for CSUS demographic information only. Whether or not you are a CSUS alumnus will have no impact on your CHHS LDA application.

Yes
No
Number of years in State Service:

Essay Questions

CHHS Core Competency situations:

Describe 2 situations within the last 5 years where you applied one or more of the CHHS Core Competencies. In your response, please describe what actions you took, the outcome(s) and how the competencies you applied positively contributed to the outcome(s)?

Your strongest Core Competency:

What do you believe your strongest Core Competency is and why? Which Core Competency presents your biggest opportunity for growth and why?

Describe 2 critical issues you face:

Describe 2 critical issues you face, how they impact your department and how you hope to leverage the skills you learn from LDA to address these same issues.

What do you expect to learn from LDA:

What do you expect to learn from LDA? How do you hope to use the learning to help the CHHS Agency achieve its vision in the future?

What you hope to achieve in your career:

What do you hope to achieve in your career within the next 5 years?

Resume

Date Resume emailed:

Please provide the date you emailed your resume to christina.m.chavez@csus.edu

Applicant's Sponsor

In order to be considered, an endorsement or recommendation of your manager, previous supervisor or manager, or senior manager with whom you work on a regular basis is required. Your sponsor must explain why s/he believes you are prepared to participate in the CHHS LDA and what traits you currently demonstrate that exemplify a leader of the future. There is a separate form for the sponsor to complete.

A notification email will be sent to the sponsor. It will be your responsibility to ensure your sponsor completes the form. The sponsor endorsement forms are available on the homepage and are due by the application due date.

Sponsor First Name: Sponsor Last Name: Sponsor Email:

Certification

I certify that the information contained in this application is accurate to the best of my knowledge. I have read the LDA charter and other application materials and agree to abide by the conditions. I further certify that I will commit the necessary time to fully participate in all preparatory work and the activities associated with the Leadership Development Academy. I understand that in order to participate in the LDA I must be employed in a CHHS department.

Check the box if you agree to the statement: Yes - I certify the accuracy of the information

Privacy Policy:

The College of Continuing Education respects your right to privacy. Any information given to us when requesting course or program material will be used solely for the purpose of answering or responding to your request. We do not sell or otherwise distribute your personal information. We may, however, use it to provide you with advanced notices of our course offerings. If at any time you wish to be removed from our mailing lists, you may contact us and your request will be processed immediately.