<p> RESIDENCY APPLICATION</p><p>Mailing Address: Linda Fetters PT, PhD, FAPTA Email: [email protected] Director of Pediatric Residency USC Division of Biokinesiology & Physical Therapy Admissions Office 1540 Alcazar Street, CHP 155 Los Angeles, California 90089-9006</p><p>Applicant Information</p><p>Male Legal Name ______Female Last First Middle</p><p>Date of Birth: ______</p><p>Current Address: From ______To ______mm/yyyy mm/yyyy ______Number and Street Apt. City State Zip Code</p><p>Telephone(______) ______Cell Phone (______) ______</p><p>E-mail Address ______</p><p>The California Leadership Education in Neurodevelopmental Disabilities (CA-LEND) education program is an important component of the pediatric residency program. CA-LEND is located within the Children’s Hospital of Los Angeles (CHLA). CA-LEND uses Life Course as the primary framework, along with Maternal and Child Health (MCH) values, to educate the next generation of interdisciplinary MCH leaders and workforce in healthcare to have the necessary skills and experience for shaping appropriate and effective health policies, programs, and outcomes for children/youth with Neurodevelopmental and Other Disabilities, including Autism Spectrum Disorder and special health care needs. Our graduates will have competencies at the 4 levels of core public health services for the MCH population: (1) Infrastructure Building (2) Population Based Services; (3) Enabling Services and (4) Direct Health Care Services. Graduates will be able to provide and ensure high-quality, cost-effective, community-based integrated services in the communities they work in within a coordinated, culturally competent, family-centered orientation. They will also develop skills to effect systems change through research, policy and inter-agency collaborations, particularly with Title V agencies and to cultivate interdisciplinary practice and research in new settings, including those which emphasize primary care or uni-disciplinary or multidisciplinary methods. A special focus is on unserved and underserved populations, which already includes the majority of families seen at CHLA and our community-based partnerships.</p><p>Please answer these two questions as they relate to your participation in the pediatric residency program and the CA-LEND program. Please use no more than 1 page for each question. Please include your answers within this application form and not as a separate document. Email your application and a copy of your CV to Linda Fetters [email protected]</p><p>1) Describe how you have demonstrated leadership in the past (either personally or professionally).</p><p>2) How will involvement in the CA-LEND training program help you achieve your professional goals? Include information about your experience or work (if any) with children, families and persons with neurodevelopmental disabilities, including the diagnosis of autism spectrum disorder, or chronic health conditions. Include special areas of interest. </p>