2013 Palatucci Advocacy Leadership Forum Online Application

Who can apply for the Forum?

The Academy seeks applicants who possess strong leadership potential and have a clear passion for their patients and their profession. Only members of the American Academy of Neurology who are in good standing may apply for the Donald M. Palatucci Advocacy Leadership Forum.

How do I apply for the Forum?

By providing your background information, a summary of your advocacy and leadership experience, and responses to the following application questions:

• Why do you want to become a Palatucci Advocacy Leader? In other words, how do you envision applying the skills to have significant impact on yourself, your patients, or the neurology profession?
• What issue motivated you to apply? Applicants should have a specific media or policy goal to pursue during this training. What would you like to accomplish as an advocate? Will your goal focus more on media outreach (public education and awareness-building) or policy (work with boards, state or federal policymakers toward policy change)? Your goal may include elements of both.
• What do you believe are the important messages that need to be heard by the public and policymakers regarding your issue?
• As a busy professional, how will you make time to pursue your issue?
• Give an example of leadership/ advocacy experience you have. Was there a time when you demonstrated leadership and/or collaborative skills to overcome an obstacle?

What makes a great application?

The following are some ideas for crafting an outstanding application:

• Describe how you possess the desire, skills, and knowledge to make change at some level
• Tell a story that exhibits your passion for the profession and your patients
• Outline examples that highlight your strategic thinking and planning skills
• Give an example of your perseverance and dedication to a selected project
• Demonstrate your ability to collaborate and network with outside groups to accomplish an objective
• Give an example of when you have motivated your peers to join you in your advocacy

Who will be selected?

The Academy will select 30 members for the training program, typically 27 members from the US and three international members. The application process for the Forum is highly competitive, especially for international members. If you are not invited to the Forum after applying, don't be discouraged! Some of the Forum's most successful graduates were not accepted to the program based on their first application.

How are Advocates selected?

Applications are evaluated by members of the Academy's Government Relations Committee and Academy staff based on the following criteria:

• Strong leadership potential and good character, clear passion for the profession and patients, and a desire to make organizational change
• Applicant's ability to think and plan strategically, communicate effectively, motivate others and collaborate/network - based on previous experience and responses to questions

Application Instructions

This form must be completed and submitted online in order to apply to participate in the Palatucci Advocacy Leadership Forum. Please review the Application Process and Guidelines for information on the Forum and what is expected of participants.

• Fields with a red asterisk (*) must be completed or the form cannot be submitted.
• Your contact information has been automatically filled in with information from the AAN member database. Please review it to make sure it is up to date and enter any changes. All information, including your notification letter, will go to this address.
• The demographic information helps us better understand the characteristics of members applying for this program.
• The application asks five narrative. Please answer each question with a succinct yet complete narrative paragraph. For example "See Above" is not an appropriate answer.
• What advocacy issue motivated you to apply for the Palatucci Forum?
• Please provide your definition of advocacy and give one example of an effective advocate.
• Why do you want to be trained as an advocacy leader?
• How do you envision applying the skills (media, grassroots, action planning) that you would learn at the program?
• What past advocacy/leadership experience do you have? Provide at least one example of a time when you demonstrated leadership and/or collaborative skills to overcome an obstacle.

Application Tips

• Save your essay answers in a Word document in case there is any problem with the electronic submission process.
• If you need to go back to a previous page in the application, use the “Step” navigation links above or the “Back” button on your Internet browser.
• You may click the save button at any time to save your progress. You can choose to save your application and return to it as many times as needed up until the deadline. However, once you click submit, you will no longer have access to your application.

You will be able to save your application as you go along. Your application will not be completed until you hit the submit button. After you have completed the form, you will have a final opportunity to review and edit your answers before you submit them. You will receive confirmation that your submission has been received.

If you have any questions about this application or the Forum, please contact Melissa Showers at mshowers@aan.com or (612) 928-6056.

This application must be completed and submitted online in order to apply to be an Advisor in 2013. Please review the Advisor Application Process and Guidelines for information on the Advisor program and what is expected of participants.

Instructions

• Fields with a red asterisk (*) must be completed or the form cannot be submitted.
• Your contact information has been automatically filled in with information from the AAN member database. Please review it to make sure it is up to date and enter any changes. All information, including your notification letter, will go to this address.
• The application asks five narrative questions:
• Since graduating from the Forum, what advocacy/leadership activities have you been involved with? (If possible, refer back to your advocacy action plan.)
• What victories or successes in advocacy have you had in the past few months?
• What barriers have you encountered that limit your ability to achieve your advocacy goals? How have you or how do you plan to overcome these barriers?
• Tell us how you envision advising your Palatucci Advocates throughout 2013.
• You will also be required to download a advisor poster template, complete a sample poster (no longer than one page), then upload it as part of your application

Tips

• You may want to save your narrative answers in a Word document, as well as your copy of the advisor poster in case there is any problem with the electronic submission process.
• If you need to go back to a previous page in the application, use the "Step" navigation links above or the "Back" button on your Internet browser.
• You may click the save button at any time to save your progress. You can choose to save your application and return to it as many times as needed up until the deadline. However, once you click submit, you will no longer have access to your application.

You will be able to save your application as you go along. Your application will not be completed until you hit the submit button. After you have completed the form, you will have a final opportunity to review and edit your answers before you submit them. You will receive confirmation that your submission has been received.

If you have any questions about this application or the Advisor program, please contact Melissa Showers at mshowers@aan.com or (612) 928-6056.

Faculty Responsibilities and Requirements:

Pre-Forum

• If accepted, initiate contact with assigned Advocates and Advisors
• Assist in developing Advisor training materials

Onsite

• Assist in the presentation/ facilitation of Forum activities
• Lead Advisor training presentation
• Give constructive feedback to Advocates during the Media training
• Provide action plan guidance and advice to assigned advocates
• Provide advanced coaching advise to assigned Advisors

Post-Forum

• Coach up to 4 advocates and 3 Advisors through 2013
• Follow up with advocates regarding action plan progress
• If possible, make advocacy presentations at state neurological society meetings
• Promote the Academy's strategic advocacy goals

Faculty will be Academy members who have attended the Palatucci Forum once as an Advocate and at least once as an Advisor. They are expected to have additional expertise and experience in Advocacy and Legislative efforts as well as Media Communications. Faculty will be assigned at least two Advocates and three Advisors whom they will be responsible for and will be asked to contact prior to arriving at the Forum. After the Forum they will be expected to contact their Advocates and Advisors to follow up and encourage ongoing Advocacy activities.