LDC	Warren Brandli Leadership Internship Call for Applicants

About the Program

CSPD is accepting applications for the Warren Brandli Leadership Intern program for 2013 -2014. This wonderful opportunity for leadership development is a program specifically designed for current pediatric dental residents or colleagues who are in their first 5 year period after completing their postgraduate training. The objective of the program is to introduce the selected intern to the inner workings of CSPD, including the art of organizational governance and the importance of child advocacy. This will help set the stage for providing young hopeful leaders the knowledge and confidence necessary to further become involved with CSPD, AAPD, CDA and other dental and related organizations. The internship serves as the true breeding ground for our future leaders in pediatric dentistry.

Participation within the program will require the intern to attend and participate in all CSPD board of director meetings for the year. The CSPD supports the participant's travel and lodging expenses. The intern will be assigned a leadership mentor who will guide him or her throughout the year. The due date for the application is November 10, 2012 for the 2013 - 2014 term beginning in April 2013 at the annual CSPD meeting.

Applications, and further information, can be obtained on the CSPD website www.CSPD.org, Leadership Development page.

The Leadership Development Committee thanks you for your interest and your dedication to the mission and goals of CSPD.

Application Form

Warren Brandli Leadership Internship
California Society of Pediatric Dentistry

This electronic form will be sent to:

Dr. Santos Cortez
3320 Los Coyotes Diag., Ste. 200
Long Beach, CA 90808
Phone: (562) 377-1375
email: LDC@cspd.org

Personal Information
Full Name
Full Mailing Address
Full Office Address
Email Address
Office Phone
Cell Phone
Alternate Phone
FAX Number
Education and Training Information
Pediatric Postgraduate Training Program:
Name of Program Director:
Date of completion of Pediatric Dentistry Program:
Undergraduate dental school and year of graduation:
Plans for or current professional activity after completion of residency program.
Note: Applicants must be student members or in the process of applying for membership to CSPD.
Are you currently a member of CSPD?
Personal Information Please submit a brief personal statement on, "Why you want to participate in the CSPD Leadership Internship Program and what do you hope to gain from this experience. "
Personal statement:
Please provide pertinent leadership activities and experiences in organized dentistry and other organizations including organization positions and year(s) held. "
Leadership activities and experiences:
Required Letter of Recommendation Please provide two letters of recommendation. One letter should be from your current or previous residency program director and should comment on your leadership abilities and describe how you are likely to use this experience to better the oral health of children through advocacy, political action or involvement in organized dentistry. The required letter of recommendation may be sent to: Ray E. Stewart, DMD CSPD Executive Director P. O. Box 221608 Carmel, CA 93922 Telephone (831) 625-2773 Fax (831) 624-2215 E-mail drrstewart(at)aol.com Requirements and Activities of the Program are: Attend all major CSPD governance/advocacy activities. Attend conferences and inter-professional meetings between CSPD and other organizations. Participate in committee, council or task force meetings as assigned. Participate in the planning and implementation of CSPD activities during the internship period. Complete an intern project on a topic mutually agreed upon with an assigned CSPD mentor and present the results at the CSPD Annual Session. Contribute material to the CSPD website. I understand that if I am selected, I will need to comply with the Requirements and Activities of the CSPD Warren Brandli Leadership Intern Program. YES NO Deadline Applications and Letters of Recommendations are due on November 10, 2012, by end of business day.