n.

The

Northeast Florida Counts

Presents

Change Agent Leadership Scholarships 2011 2012

Application Deadline April 15, 2012 Northeast Florida Counts (www.nefloridacounts.org) is a dynamic one-stop source of health and quality of life data that provides easy to understand health, environmental and other sustainability indicators for Northeast Florida. This innovative website also links its visitors to promising practices and resources that encourage and promote informed community action. The site serves as a road map for collaborative community improvement by highlighting where we have been, our current status, and directing where we need to go. It is intended to help planners, policy makers, community members and students learn about health related issues and identify improvements. It is an invaluable tool for conducting community assessments, strategic planning, collaboration, community capacity development, grant development, and advocacy efforts. The Change Agent Leadership Scholarship (CALS) is funded and awarded by the Partners* of Northeast Florida Counts - a health-related quality of life data initiative of the Health Planning Council of Northeast Florida (501c3). The CALS award is a one-year, nonrenewable scholarship in the amount of $2,500.00 to help defer educational costs for a period of one years matriculation at any accredited two or four year College or University. Two $2,500.00 CALS will be awarded each year. Each scholarship recipient will also be invited to and recognized at the Health Planning Councils Annual Meeting in October 2012. The CALS determination is not based on the students financial need or grade point average but rather on the students visionary aptitude and leadership ability to create a plan to transform a Northeast Florida community of their choosing into a vibrant and healthy place to live, work, and play. Interested candidates of the CALS scholarship are NOT limited to students seeking healthrelated degrees. Students interested in pursuing degrees other than health-related degrees are strongly encouraged to apply (See Attachment 1). The Award(s) shall be presented contingent to the following conditions: The student is a legal resident of Baker, Clay, Duval, Flagler, Nassau, St. Johns or Volusia counties, Florida. The student provides a completed application packet to the Health Planning Council of Northeast Florida by the specified deadline listed below.

The student must be completing their last year of high school and/or GED program. The student is accepted for admission to any USDOE accredited two- or four-year college or university as a full-time, degree-seeking student. Using the data indicators, best practices, and news located on Northeast Florida Counts, the student will develop a solid and thoughtful essay that demonstrates that they researched, identified and created evidence based solutions for improving the health and quality of life of a Northeast Florida community. Finalists for the scholarship will be required to provide a 20 minute interactive presentation to a panel of judges at The Change Agent Leadership Scholarship Awards Ceremony following the Hale & Hearty 7K race (www.haleandhearty7K.com) on June 2 2012 at 7:00 PM at the Riverside Arts Market in Jacksonville Florida. Two $2,500.00 Scholarships will be awarded during The Change Agent Leadership Scholarship Awards Ceremony on June 2, 2012.

The scholarship packet is complete when it includes: Two page essay (see directions on following page). Completed application with students current GPA (including second grading period of grade 12). A letter of recommendation from each of the following: 1) A member of the students high school faculty; 2) A community representative; 3) An adult of the students choice. No family members permitted. Please specify relationship to applicant.

Academics: To be completed by Guidance Counselor Have your guidance counselor fill in the following information. A transcript may be included with your application, but is not required. Grade point average: Weighted ________________ Unweighted ______________ Class rank/standing: ___________________________________(Such as, 5th of 355) Has the student taken the SAT: Yes___ or No ___ ACT: Yes___ or No ___

Student has been accepted to which college or university? __________________________ Counselors signature: ________________________________ Date: ____________

Leadership & Extracurricular activities: To be completed by student List all leadership positions and extracurricular activities in which you have participated during high school, such as community service projects, sports, band, church groups, etc. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

Essay: To be completed by student Using double spaced, one-inch margins, and 12 point Times New Roman or Ariel font, develop a two page essay that demonstrates that the student researched, identified and created evidence-based solutions for improving the health and quality of life of a Northeast Florida community. Essay should clearly include the following points: In the students own words, describe the qualities of a healthy community. Identify the health-related community issue(s) within a specific county using the community indicators and demographic population data on Northeast Florida Counts. Provide a rationale for why this health-related community issue is important to improving the health and quality of life of a community using the news archives on Northeast Florida Counts and other sources of information. Using the best practice repository located on Northeast Florida Counts, identify and describe the evidence-based solution(s) that the student believes can move the needle and create better outcomes in the community. Describe how the student proposes to employ a collaborative approach to tackle the community issue.

Resources to Assist with Essay: www.neflcounts.org http://www.cdc.gov/healthycommunitiesprogram/ http://www.cdc.gov/hrqol/ http://aspe.hhs.gov/ezec/healthec/index.htm

www.haleandhearty7K.com

I certify that the information on this form and provided with this application is correct. If awarded the Change Agent Leadership Scholarship (CALS), I agree to be photographed for use in the regional newspapers, partner newsletters and websites, and for possible use in other publications of general circulation. I also agree to provide a copy of my letter of acceptance and evidence of attendance from the college/university. Finally, I agree to return all funds awarded to me if I withdraw from school prior to successful completion of the present academic grading period, or the grading period to which the scholarship is applied.

_______________________________________________ ________________________ Applicants signature Date

_______________________________________________ ________________________ Parents signature (if applicant is under 18 years of age) Date

Submit application by mail to: Northeast Florida Counts Steering Committee 644 Cesery Blvd. Suite 210 Jacksonville, Florida 32211

Attachment 1 Sample College Majors Business: Accounting, Advertising, Business Economics, E-commerce, Finance, Hospital and Health Care Administration, Hospitality Management, International Business, Management, Marketing, Operations Management, Real Estate Computer Science: Database Management, Digital Arts, Networking, Programming, Software Development, Systems Engineering: Aerospace Engineering, Chemical Engineering, Civil Engineering, Electrical Engineering, Environmental Engineering, Mechanical Engineering, Nuclear Engineering, Petroleum Engineering Humanities: Art, Communications, Counseling, Education, English, Foreign Languages (Italian, Spanish, French, German, Russian, Japanese, Chinese, others), Literature, Philosophy, Religious Studies, Speech, Theatre Music: Instrumental Performance, Music Education, Vocal Performance Sciences: Astronomy, Astrophysics. Biology, Biochemistry, Botany, Chemistry, Earth Science, Forestry, Genetics, Geology, Mathematics, Physics, Zoology Social Sciences: American Studies, Economics, Geography, History, Latin American Studies, Political Science, Psychology, Sociology Health and Medicine: Athletic Training, Clinical Laboratory Science, Diagnostic Medical Sonography, Foods, Nutrition, and Wellness Studies, Health Sciences, Music Therapy, Nursing, Physical Therapy, Physician Assistance, Pre-dentistry, Pre-medicine, Pre-pharmacy, Pre-veterinary Studies, Public Health, Speech-Language, Pathology and Audiology, Veterinary Technology

Partners
Baker County Health Department Baptist Health Brooks Rehabilitation Clay County Health Department Council on Aging of Volusia County of Volusia Duval County Health Department Flagler County Health Department Flagler Hospital Florida Hospital Halifax Health Mayo Clinic Memorial Health Jacksonville Nassau Alcohol Crime Drug Abatement Coalition Nassau County Health Department Northeast Florida Health Services Northeast Florida Healthy Start Coalition The Healthy Start Coalition of Flagler and Volusia, Inc. One Voice for Volusia Shands Jacksonville St. Johns County Health Department

St. Johns River Rural Health Network, Inc. St. Vincents Healthcare Stewart Marchman Act Sutton Place Behavioral Health Volusia County Health Department Volusia/Flagler YMCA United Way of Volusia/Flagler