Florida Dietetic Association: Levina Phillips Leadership & Emerging Leader Scholarship Application

Levina Phillips Leadership & Emerging Leader Application
(Please submit by April 1 for Spring and September 15 for Fall)

Applying for the following stipend:

First Name: Middle Initial: Last Name:

ADA Number:

Address Line 1:

Address Line 2:

City:

State: FL

Zip Code: -

Email Address:

Telephone: ( ) -

FAX: ( ) -

Educational event for which you would like to receive grant:

Educational event dates for which you would like to receive grant:

Event Start Date: / /

Event End Date: / /

Cost to attend, include proposed expenses: $

Amount of grant you would like to receive: $

Explain how the educational event will enhance candidate's leadership skills in dietetics practice and/or association:

Candidate's objective for the educational event:

Does the Commission on Dietetic Registration approve this educational event?

Yes No N/A

How does this educational event contribute to the candidate's continuing education plan?

Member of the ADA since: (year)

Number of years lived in Florida:

Member of FDA since: (year)

Member of District: Since: (year)

Present position and major responsibilities:

Leadership position(s) held in the Florida Dietetic Association and date(s):

Leadership position(s) held in local dietetic associations and date(s):

For Emerging Leader only:

List elected or appointed positions and date(s) held in District:

Have District President or Past President send documentation under separate cover with application form.

Evidence of attendance: I agree to provide evidence of attendance at the event, a voucher to document costs and to provide a written report to the FDAF scholarship committee chairperson regarding objective(s) attained as a result of attendance.

Select from one of the following workshops:

Public Policy: ADA Leadership: FDA Annual Symposium Leadership: * Other:
* If selecting Other, e-mail program details, or attach file containing the details. (Enter file name or click "Browse..." to browse your computer to select the file.)
Attach Other Program:

Electronic Signature (required): Please check this box if you agree your information is accurate. FDA is not responsible for any information not provided.

The Florida Dietetic Association Foundation (FDAF) has established the Levina Phillips Leadership Stipend Grant Fund to help members who have been active in leadership positions in the state and district associations by providing direct funding for continuing education for these FDAF members to enhance their leadership skills. This is the first FDAF fund to provide financial assistance to its own members. We want to build a financial base and use the interest or dividends to fund grants.

Levina Phillips was president of the Florida Dietetic Association from 1969-70 and served the association in many other capacities during her interesting career in Florida. Her career began in hospital dietetics and then she moved to public health. She was Nutrition Director in the Dade County Department of Public Health and started one of the first local WIC programs in the state in 1974. Levina also served as district nutrition consultant for HRS District 8 that covered eight counties in southwest Florida. She was a friend and mentor to many of us and provided inspiration for our professional lives. Levina passed away in April, 1998.

Levina saw the need to assist dietetic students financially and persuaded the Florida Dietetic Association Foundation to establish the Sister Helen Marie Scholarship - the first FDAF scholarship fund. Because of her strong belief in the value of education, the FDAF Board of Directors decided to establish a fund for use by practicing dietitians. Examples of possible educational events include professional meetings, leadership workshops and short courses in areas such as maternal and child health, cardiovascular disease, foodservice management, information technology or alternative medicine.