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2026/2027 EH Leadership Academy Application
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1.
Your information
(Required.)
Name
Address
Address 2
City/Town
State/Province
ZIP/Postal Code
Work Email Address
Personal Email Address
Phone Number
*
2.
Employment Information
(Required.)
Agency Name (full name, no abbreviation)
Address
Address 2
City/Town
State/Province
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP/Postal Code
Website
Phone Number
*
3.
Agency type
(Required.)
Local
State
Territorial
Tribal
Other (please specify)
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4.
Do you work full time for this agency?
(Required.)
Yes
No
Other (please specify)
*
5.
Supervisor's name
(Required.)
*
6.
Supervisor's email
(Required.)
*
7.
Supervisor's Phone Number
(Required.)
*
8.
Do you currently hold a Registered Environmental Health Specialist/Registered Sanitarian credential?
(Required.)
Yes
No
9.
What agency issues your REHS/RS credential?
*
10.
Are you a current member of NEHA?
(Required.)
Yes
No
*
11.
Please indicate if you are a member of a NEHA affiliate.
(Required.)
Alabama Environmental Health Association
Alaska Environmental Health Association
Arizona Environmental Health Association
Arkansas Society of Professional Sanitarians
Business and Industry Affiliate
California Environmental Health Association
Colorado Environmental Health Association
Connecticut Environmental Health Association
Florida Environmental Health Association
Georgia Environmental Health Association
Idaho Environmental Health Association
Illinois Environmental Health Association
Indiana Environmental Health Association
Iowa Environmental Health Association
Jamaica (IPO)
Kansas Environmental Health Association
Kentucky Environmental Health Association
Louisiana Environmental Health Association
Massachusetts Environmental Health Association
Michigan Environmental Health Association
Minnesota Environmental Health Association
Missouri Environmental Health Association
Montana Environmental Health Association
National Capital Area Environmental Health Association
Nebraska Environmental Health Association
Nevada Environmental Health Association
New Jersey Environmental Health Association
New Mexico Environmental Health Association
New York State Conference of EH Directors
North Carolina Public Health Association- EH Section
North Dakota Environmental Health Association
Northern New England Environmental Health Association
Ohio Environmental Health Association
Oklahoma Society of Environmental Health Professionals
Oregon Environmental Health Association
Past Presidents
Rhode Island Environmental Health Association
EH section of South Carolina Public Health Association
Tennessee Environmental Health Association
Texas Environmental Health Association
Uniformed Services Environmental Health Association
Utah Environmental Health Association
Virginia Environmental Health Association
Washington State Environmental Health Association
West Virginia Association of Sanitarians
Wisconsin Environmental Health Association
Wyoming Environmental Health Association
I am not a member of a NEHA affiliate.
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12.
Staff size of workforce
(Required.)
1-10
11-25
26-50
51+
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13.
Job title
(Required.)
*
14.
Job responsibilities
(Required.)
*
15.
Years of environmental health experience
(Required.)
*
16.
In-person attendance at the NEHA's 2027 Annual Educational Conference (AEC) is mandatory. The 2027 AEC location is Portland, Oregon from June 28 – July 1, 2027. Can you commit to attending?
(Required.)
Yes
No
Maybe
*
17.
Please list any other leadership training programs you have attended.
(Required.)
*
18.
What areas of environmental health have you worked in? (Check all that apply)
(Required.)
Aquatic Health / Recreational Waters
Climate & Health
Data and Informatics
Emergency Preparedness & Response
Food Safety
Healthy Homes & Communities
Indoor Air Quality
Infectious & Vector-borne Diseases
On-site Wastewater
Outdoor Air Quality
Solid and Hazardous Waste
Water Quality (Drinking water, Stormwater, etc.)
Other (please specify)
*
19.
Please list all credentials, certifications, and/or degrees
(Required.)
*
20.
A one-page letter of support to participate in this program from your department head or immediate supervisor is required. This letter should detail your accomplishments, why they feel you would be a good fit for the program, and their understanding of the time commitment involved. Either upload a copy here (preferred) or email a PDF copy to ehlaprogram@neha.org.
(Required.)
Choose File
No file chosen
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21.
Please provide a personal statement, so we can learn more about you. Your statement should be no more than 500 words and include your motivation, what you expect to gain, and how participating in NEHA’s Leadership Academy aligns with your EH career. Also, include any other information that you believe makes you a good candidate. Tip: Keep your writing sincere, concise and focused on your career.
(Required.)
*
22.
The tuition for this program is $2,000. Will your employer be able to provide financial assistance for you to attend program?
(Required.)
Yes
No
Unsure
23.
Partial, nominal tuition assistance may be available. Please provide a description of why you require financial support.
24.
By typing your full name below, I hereby certify that the above information is complete and accurate. I also fully understand and agree to the following:
• Provide a written letter of support from my department head or supervisor to be a part of this leadership academy. Written letter of support must be submitted with the application.
• Attend all online training modules of NEHA’s leadership program, which requires a commitment of one year. The modules will be once a month and last 4 hours.
• Show up on time to all online and in-person program modules, ready to learn.
• Complete all required pre- and post- module course assignments on time.
• Engage in dialogue with fellow program participants and instructors to enrich the program.
• Participate in group settings when the program assignment demands such.
• Agree to participate in one-on-one and/or group sessions with a mentor for a set amount of time, once a month.
•Complete all post module and program evaluations.
• Provide feedback on program content and materials to the leadership program’s administrative team to help improve the program.
• Work on an independent year-end capstone project which must benefit either your organization, community served, or the EH workforce.
• Attend all activities associated with the leadership academy at NEHA’s 2027 Annual Educational Conference. Please be aware that the cost of AEC registration and any travel or lodging are not included in the program fee.
• Be a NEHA member in good standing throughout the entirety of the program.