Application

The next Public Health Innovation Summit & Showcase (Summit) will take place on the afternoons of September 28-29 from 12-4PM ET.   We aim to bring together innovators from the field to share and learn from each other to shape the future of public health. To ensure the Summit field driven and responsible, we need you.

We seek public health professionals who consider themselves innovators and are looking for an opportunity to share their perspectives and work with other innovators to direct us into the public health of 2021 and beyond.
 
There are two ways you can join us:
  1. To attend and participate - complete the form below that asks for narrative on why you’d like to attend and what you can share with other participants.
  2. To present - complete the application to participate (#1) and then submit an abstract describing your innovations work and how it can best be shared with other participants.
 
Note that information from the applications may be shared with other participants. 
 
Applications for both options close May 12th and you can expect to hear from us by early June. Click here to view the full application prior to completing the form below.
 
View the PDF of the forms here.
Questions? Contact info@phnci.org 

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* 1. Full Name

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* 2. Title, Role, or Subject Matter Area

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* 3. E-mail Address

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* 4. Organization (enter N/A if none)

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* 6. Tell us a bit about who you are, what inspires you, and your connection to public health. (125 words)

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* 7. How are you an innovator/innovative in your public health work? How have you interacted with creativity, risk-taking and failing forward?  What steps have you taken to foster a culture of innovation in your organization or community?  Reference the definition of innovation in your response. (125 words)

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* 8. We aim to have a virtual room full of innovators who can both learn from each other and to support ideating around 21st Century public health. To that end, what experience, insights and/or knowledge would you bring to the Summit to share with other attendees and to foster innovation in public health practice (125 words)

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* 9. What is one thing you would like to see on the agenda for the Summit? (25 words)

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* 10. What do you think is needed for public health moving forward? (25 words)

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* 11. During the Summit, we will have 'creativity spotlights' throughout our time together. Do you have a narrative, artistic interpretation, poem, etc. that you'd like to share during the Summit?

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* 12. If your application is accepted, confirm that you/your organization will pay the $150 registration fee. 

Applicants who are willing to craft an innovation, or fail forward, story with PHNCI prior to registration will be eligible for reduced or waived registration.  The stories form can be found here, and we will be in touch if we decide to move forward with crafting a full story.

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* 13. If accepted, would you like to engage with us in the following (check all that apply):

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* 14. Did you attend the 1st Annual Public Health Summit & Showcase (March 2019, Philadelphia, PA)?

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* 15. Are you interested in submitting an abstract to present at the Summit & Showcase? (Select "Yes" and click Submit to be taken to the abstract application form. Select "No" and click Submit to complete submission of the participant form.)

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