Ghana Nurse Leaders Program
APPLICATION FOR ADMISSION
COHORT III
The program consists of 2 weeks of instruction with action learning periods between each program week.
1-5 June 2015* –Training week 1 in Accra, Ghana
5-9 October 2015* – Training week 2 in New York City, USA
June 2016 – Program completion
*Dates subject to change
Program participants must be able to travel to New York City and have a valid passport through May 2016.
The Colleges of Nursing of New York University and the University of Ghana, Legon, Mujeres Por Africa
Foundation of Spain, and the Ghana Ministry of Health seek to enroll ten female nurses to participate in the third
cohort of a year-long leadership development program.
This women’s leadership program is designed to promote participant’s abilities to lead in the innovation of patient
care services and the strengthening of Ghana’s health system.
At the completion of the Ghana Nurse Leaders Program participants will be able to:
 Identify personal strengths and weaknesses as a leader
 Create a personal action plan to improve leadership effectiveness
 Effectively manage teams
 Provide effective performance feedback to promote clinical practice excellence
 Apply principles, practices, and models of organizational change
 Use quality and safety principles and methods to improve clinical care
 Apply the chronic care model to clinical practice settings
 Evaluate the outcomes of a clinical change project
ELIGIBILITY
The Ghana Nurse Leaders Program is open to women nurses working in the public healthcare system in
Ghana.
The ideal program participant has established herself as a leader in either a formal management position or
through professional activities.
Applicants should hold a first degree; hold the rank of senior nursing officer (S.N.O.) or principal nursing officer
(P.N.O.); and have approximately 10-15 more career years in the health service.
Proficiency in written and spoken English is essential for participation in the Ghana Nurse Leaders Program.
Interested nurses who meet the above criteria may follow the instructions below to submit their applications.
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Directions: Type application using 12 point font. Incomplete applications will not be reviewed. Submit a resume and
letters of support from (1) the highest ranking nurse officer and (2) direct supervisor with your application.
I. GENERAL INFORMATION
NAME:
Surname
First Name
Middle (name/initial)
DATE OF BIRTH:
MARITAL STATUS:
Single
Married
NUMBER OF CHILDREN (0-18 years) OR DEPENDENTS LIVING AT HOME:
HOME ADDRESS:
PREFERRED MAILING ADDRES:
PHONE NUMBER:
CELL NUMBER:
EMAIL ADDRESS:
POSITION/TITLE:
ORGANIZATION NAME:
ORGANIZATION ADDRESS:
TELEPHONE:
FAX NUMBER:
TYPE OF ORGANIZATION:
Community Health Center
Rural Health Center
District Hospital
Regional Hospital
PolyClinic
Teaching Hospital
Maternity Home
Other (specify): _______________________________________
SECTOR:
Ghana Health Service
Quasi-Government Hospital
Other (specify): _______________________________
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HEALTH SYSTEM ADMINISTRATIVE REGION/GEOGRAPHIC LOCATION (where you work):
Greater Accra
Volta
Central
Western
Eastern
Ashanti
Brong-Ahafo
Northern
Upper West
Upper East
WORK HOURS PER WEEK/SHIFT WORKED:
II. WORK EXPERIENCE & RESPONSIBILITIES
BRIEFLY DESCRIBE THE ORGANIZATION IN WHICH YOU WORK.
WHAT IS THE TITLE OF THE PERSON TO WHOM YOU REPORT? ________________________________________
WHAT IS THE NUMBER OF PEOPLE WHO REPORT TO YOU? ___________________________________________
BRIEFLY DESCRIBE YOUR CURRENT RESPONSIBILITIES, INCLUDING YOUR LEVEL IN THE ORGANIZATION.
ESTIMATE YOUR TOTAL YEARS OF EXPERIENCE IN NURSING: _________________________________________
IF YOU ARE IN A FORMAL MANAGEMENT POSITION, ESTIMATE THE NUMBER OF YEARS YOU HAVE BEEN A
MANAGER: ___________________________________________________________________________________
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III. EDUCATION AND PROFESSIONAL TRAINING
NURSE TRAINING PROGRAM:
School Name
Location
Graduate Date
Location
Graduate Date
Location
Graduate Date
Location
Graduate Date
BACHELORS DEGREE PROGRAM:
School Name
MASTERS DEGREE PROGRAM:
School Name
OTHER DEGREE PROGRAM:
School Name
MEMBERSHIP IN PROFESSIONAL/CIVIC/RELIGIOUS ORGANIZATIONS (Name up to 4 organizations, dates and role, if
any in the organization)
Have you attended a leadership development program in the past?
Yes
No
If yes, briefly describe the program including the place, dates, and key features of the program.
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Have you previously attended a study-abroad session?
Yes
No
If yes, briefly describe the program including the place, dates, and key features of the program.
IV. PERSONAL STATEMENT
1) Please state your goals and objectives as they relate to attending the Ghana Nurse Leaders Program. Also
describe what you think other program participants may learn from you (e.g.: skills, expertise, perspectives). No
more than 2 paragraphs.
2) Briefly describe your leadership style and approach. No more than 2 paragraphs.
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3) Describe a situation in which you took a leadership role and helped to affect change. No more than 2
paragraphs.
4) In a one paragraph summary, please describe your current leadership challenge(s) especially in relation to your
role as a leader.
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V. CHANGE PROJECT STATEMENT
An important part of the Ghana Nurse Leaders Program is the opportunity to design and implement a service
change project in your organization. In one page or less, briefly describe a project that you would like to undertake
for the program. Describe the problem that you seek to address, the project goals, and the intended service
improvements that you seek to realize.
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PARTICIPATION AGREEMENT
By submitting this application, I agree to commit the time required and offer my full participation and engagement if
I am selected to participate in the Ghana Nurse Leaders Program.
If selected, participants are responsible for obtaining a visa to travel to New York City for the second week of
the program.
I understand that if accepted, I am responsible for securing appropriate work-release time for all training events.
I understand that if accepted, this program is designed for individuals who intend to continue their employment
in Ghana in the health sector for at least 3 years from the end of their participation in the Ghana Nurse Leaders
Program.
Applicant signature
Date
TRAVEL AND EXPENSES
The program will cover all travel and living expenses associated with the training week in New York City, U.S.A.
Lodging and meals will be covered by the program during the training week in Accra, Ghana. Participants are
responsible for domestic travel to Accra.
Tell us how you learned about this opportunity: (Type or write below)
PLEASE RETURN THIS APPLICATION BY 30 MARCH 2015. YOU CAN SUBMIT YOUR
APPLICATION IN THE FOLLOWING WAYS:
BY EMAIL:
BY MAIL:
HAND DELIVERED:
To: Katie Dittmer
Email: kad501@nyu.edu
Subject: “Attention: Ghana Nurse
Leaders Application Submission”
Ms. Akosua Anidoho
New York University Accra
Ghana Nurse Leaders Program
PMB C84
Cantonments
Accra
Ms. Akosua Anidoho
New York University Accra
Ghana Nurse Leaders Program
3rd Norla Street No. 8,
North Labone
Accra
For queries on the status of your submitted application, please contact Ms. Akosua Anidoho Email: aa100@gmail.com.Phone: 233 21 761528.
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