Supported by the AAP EHDI Provider Education Center 

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $300,000 with 0% financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government. 

The American Academy of Pediatrics (AAP) Early Hearing Detection and Intervention Provider Education Center (EHDI PEC), with support from the Maternal and Child Health Bureau (MCHB), is excited to launch the Emerging Leaders Program. This initiative is aimed at increasing knowledge, confidence, and leadership skills among healthcare providers working within the EHDI system. Participants will engage in interdisciplinary mentorship, networking, and training while contributing to the development of an innovative training EHDI curriculum to support other programs nationwide

If you are interested in this opportunity, complete this application form.
Please note, all participants are expected to have read and reviewed the Call for Applications for full program details.

Question Title

* 1. Please provide the following personal and professional details:

Question Title

* 2. Discipline/Field of Practice:
For this cohort, we are focusing on primary care providers who serve children. Please indicate the type of primary care provider you are or the type of provider you are, noting that you do not need to be a pediatric provider to apply:

Question Title

* 3. Please indicate the location of the patients/families you serve (check all that apply):

Question Title

* 4. Have you previously participated in any mentorship or training programs specifically related to EHDI? If so, please describe the programs you've been involved in, including the scope of the program and any key insights or skills you gained.

Question Title

* 5. If yes, please provide details in open comment box (limit 200 words)

Question Title

* 6. Please submit a resume, CV, or NIH biosketch. We ask that your submission be limited to 4 pages maximum.

PDF, DOC, DOCX, PNG, JPG, JPEG file types only.
Choose File

Question Title

* 7. Which of the following racial/ethnic designations best describe you? Please check all that apply:

Question Title

* 8. What is your gender identity:

Question Title

* 9. Do you identify as d/Deaf or hard of hearing?

Question Title

* 10. Why are you interested in participating in the EHDI PEC Emerging Leaders Program? (Include any relevant skills, knowledge, or experiences you hope to gain or contribute. Please keep your response within 300 words)

Question Title

* 11. What do you hope to achieve through mentorship and participation in this program? (Include any specific areas of leadership, clinical skills, or systems knowledge you want to develop. Please keep your response within 300 words)

Question Title

* 12. Describe any experiences you have had working with underrepresented or underserved populations, including rural or other minoritized communities: Please keep your response within 300 words.

Question Title

* 13. What is your current experience working with children who are D/HH or engaging with the EHDI system? (Please describe your involvement, including any relevant roles, responsibilities, or interactions. Keep your response within 300 words.)

Question Title

* 14. What are your current goals for professional mentorship?(What kind of mentor would you benefit from? For example, someone with expertise in the EHDI system, leadership, working with diverse populations, etc. Please keep your response within 300 words)

Question Title

* 15. Which specific skills or areas of expertise are you looking to develop through mentorship?(Check all that apply)

Question Title

* 16. Are you able to commit to participating in monthly virtual sessions and two one-on-one mentorship sessions over a 6-month period?

Question Title

* 17. Do you have any additional needs or requests to help you participate fully in this program? (e.g., accessibility accommodations)

Question Title

* 18. Is there anything else you’d like us to know about your application? (This can include any additional professional or personal experiences that are relevant)

T