HPLI Application — Healthy New Orleans

Thank you for your interest in the HPLI!

The deadline to complete an application is December 16, 2024.

Before Continuing

Please note that to complete the application, you will need to upload/input the following in addition to basic contact and demographic information: resume, hi-res head shot, bio (500 words or less), one letter of support, and contact information for 2 references.

Saving Your Work

There is no way for you to manually save your progress as you fill out the application. However, as long as you do not erase or clear your browser history, it can usually be pulled up in your browser with your responses intact.

Program Commitment

Healthy New Orleans’ Health Performing Leaders Institute is a four-month immersive leadership development experience. The program begins with an opening retreat and concludes with a closing retreat. Between those dates, participants will engage in four, full-day sessions dedicated to topics related to health promotion.

Attendance at the opening and closing retreats is mandatory. Additionally, there are 4 full-day sessions from 8:30 am – 4:30 pm once a month. Participants may miss no more than the equivalent of two program days during the year. If this commitment is not met, class members may be asked to leave without refund.

Tuition and Tuition Assistance

Full Program Tuition: $350

Tuition covers all program costs and materials, including meals and any other costs associated with the retreats and sessions. Tuition is non-refundable and may be coordinated with the Program Manager at the time of acceptance. Healthy New Orleans offers a variety of flexible payment plans to help meet your budget, as well as opportunities for tuition assistance.

If you would like to request tuition assistance, please respond within the application itself. Tuition assistance is limited and not guaranteed, and it is based on a number of variables including the availability of funds, the number of requests, and the need as demonstrated by the individual seeking assistance. Every request will receive a confidential, thorough assessment, and every effort will be made to be supportive of individuals who could not otherwise afford the tuition. Healthy New Orleans only offers partial assistance, and awards do not typically exceed 40% of the full tuition amount. Please note that selection to a HPLI class and a request for tuition assistance are independent processes, and acceptance into the program is not influenced by tuition assistance requests.

Name

First Name

Last Name

Phone

(###)

###

####

Gender

To Self-Describe, please select Other and respond within the space provided

If 'Other,' please specify

Race or Ethnicity

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Please share your bio highlighting professional and personal accomplishments.

Employer Information

Employer

In which industry do you work?

Job Title

Work Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Information

Emergency Contact

Emergency Contact Phone

Second Emergency Contact

Second Emergency Contact Phone

Allergies (Food, Dietary Restrictions, Other)

Community Involvement

Current Community Involvement

Please list current community, civic, religious, political, social, athletic or other activities in which you are involved and indicate your role in these activities at this time. Please be sure to include any Boards of Directors, Committees, Advisory Councils, etc. on which you serve. Do not include business/professional activities.

Business/Professional Affiliations

List any business/professional organizations with which you are currently active. Please be sure to include any Boards of Directors, Committees, Advisory Councils, etc. on which you serve.

Personal Perspectives

In your opinion, what does it mean for one to be a health promoting leader (250 words or more)?

What key moments informed your perspectives about your health and the health of those around you (250 words or more)?

What do you believe are the biggest health challenges facing our community (250 words or more)?

Tuition Assistance

Are you interested in tuition assistance?

Yes

If yes, how much are you requesting?

How much will your employer contribute to your tuition?

Have you asked your employer to contribute to your tuition?

Yes

Please share any circumstances or relevant information that should be considered in your request for tuition assistance.

By submitting this application, you confirm the following statement: I have read the above and understand the commitment involved in this program. I affirm that all the information listed on this application is true. I understand that it is my responsibility to update Healthy New Orleans if any of this information changes, and that the HPLI reserves the right to withdraw my acceptance due to changes in information stated in this application.

Thank you for your interest in the HPLI!

Stay in touch!