The California Innovation Playbook for Government Change Agents (Cal-IPGCA) 2018 Registration Form: August 9 - December 6, 2018

Seeking Leaders - Innovators and Change Agents...Are we talking about YOU?

Our government serves an agile society that exists in constant and ever accelerating environments of change. It's imperative that the State of California create a culture of innovation that can sustain, advance and accelerate our services to society. We are reaching out to tap into what we see as our biggest untapped innovative resource...YOU!

Under a paradigm of “Tell, Show, Let, Help” the Innovation Playbook for Government Change Agents (Cal-IPGCA) is an immersive 64-hour intrapreneurial training program that delivers great results for Californians. (Note: Each part-time, work-based trainee receives 32 hours of training.)

How does it work? California state agencies and departments are evaluating the selection of 72 full-time training seats and a maximum of (10) work-based, part-time trainees per full-time trainee candidate for the 2018 Cohort. Candidates are being selected to reflect the composition of the state's employment base. Both multi-culturally and professionally, Cal-IPGCA teams will be comprised of entry-level employees, middle management and executive level leadership- all participating as innovation partners in the Cal-IPGCA 2018 Innovation Lab.

This application will be submitted to your agency or department for review and consideration of acceptance into this program. You will not be considered for entry into Cal-IPGCA without completion of this application. No one will actually be enrolled until authorized by your agency, department or supervisor, with authorization and/or approval for full-time registration at the rate of $2850 (62 PTH) and $495 for Part-time work-based trainees (38 PTH).

Because there is a maximum number of full-time trainees allowed to participate (72 trainees), we are conducting registration on a first-come/first-served basis for qualified applicants. Applications are being reviewed by executive sponsors as they are received, with anticipated notification to the trainee within one-week of their submission.

Important Information about the Cal-IPGCA 2018:

www.kollabornation.net
USC 360-degree assessment for current and emerging leaders to aid professional development + executive coaching. This add-on but integrated program feature for full-time trainees is being offered at the discounted rate of $550.

Question Title

* 1. Applicant - Agency-Department Information

Agency or Department Name:

Applicant's First Name:

Applicant's Last Name:

Applicant's Title:

Applicant's Business Mailing Address:

City:

State:

Zip Code:

Email Address:

Work Phone Number:

Cell Phone Number:

Question Title

* 2. The scheduled training dates for Cal-IPGCA 2018 are listed below. Each training date is significant and unique. Please identify your availability for all training dates.

	YES, I can attend the full day.	NO, I cannot attend the full day.
Thursday, August 9, 2018: 8 am – 5 pm Gateway Training – Innovation Playbook for Government Change Agents (Cal-IPGCA)	Thursday, August 9, 2018: 8 am – 5 pm Gateway Training – Innovation Playbook for Government Change Agents (Cal-IPGCA) YES, I can attend the full day.	Thursday, August 9, 2018: 8 am – 5 pm Gateway Training – Innovation Playbook for Government Change Agents (Cal-IPGCA) NO, I cannot attend the full day.
Thursday, August 16, 2018: 8 am - 5 pm Innovators Forum	Thursday, August 16, 2018: 8 am - 5 pm Innovators Forum YES, I can attend the full day.	Thursday, August 16, 2018: 8 am - 5 pm Innovators Forum NO, I cannot attend the full day.
Thursday, September 13, 2018: 8 am – 5 pm Innovators Forum	Thursday, September 13, 2018: 8 am – 5 pm Innovators Forum YES, I can attend the full day.	Thursday, September 13, 2018: 8 am – 5 pm Innovators Forum NO, I cannot attend the full day.
Thursday, October 11, 2018: 8 am – 5 pm Innovators Forum	Thursday, October 11, 2018: 8 am – 5 pm Innovators Forum YES, I can attend the full day.	Thursday, October 11, 2018: 8 am – 5 pm Innovators Forum NO, I cannot attend the full day.
Thursday, November 8, 2018: 8 am – 5 pm Innovators Forum	Thursday, November 8, 2018: 8 am – 5 pm Innovators Forum YES, I can attend the full day.	Thursday, November 8, 2018: 8 am – 5 pm Innovators Forum NO, I cannot attend the full day.
Thursday, December 6, 2018: 8 am – 5 pm Cal-IPGCA Day of Innovation - Awards Ceremony	Thursday, December 6, 2018: 8 am – 5 pm Cal-IPGCA Day of Innovation - Awards Ceremony YES, I can attend the full day.	Thursday, December 6, 2018: 8 am – 5 pm Cal-IPGCA Day of Innovation - Awards Ceremony NO, I cannot attend the full day.

Question Title

* 3. How many years have you been employed by the State of California?

Question Title

* 4. Applicant's Direct Supervisor/Manager: (Note: The applicant's direct supervisor/manager will have an "audit only" seat to review the trainee's progress. The supervisor MUST approve the applicant's registration.)

Agency or Department Name:

Supervisor/Manager First Name:

Supervisor/Manager Last Name:

Supervisor's/Manager's Title:

Business Mailing Address:

City:

State:

Zip Code:

Email Address:

Phone Number:

Question Title

* 5. Status of Supervisor's/Manager's Awareness of this Submission:

	Yes	No
My supervisor/manager recommended and/or approved the submission of this application.	My supervisor/manager recommended and/or approved the submission of this application. Yes	My supervisor/manager recommended and/or approved the submission of this application. No

Question Title

* 6. The GovOps - CalHR Leadership Values guide training and development at every level of the Cal-IPGCA curriculum. Please identify your level of skill as it relates to each value. (Note: Identifying that a specific leadership value "needs development" will not hinder a candidate's consideration, but it does provide guidance in developing balanced teams.)

	Needs Improvement	Moderately Skilled	Highly Skilled
Communicate Effectively – As demonstrated by strong writing, verbal and listening skills to create an open and transparent environment for the exchange of information.	Communicate Effectively – As demonstrated by strong writing, verbal and listening skills to create an open and transparent environment for the exchange of information. Needs Improvement	Communicate Effectively – As demonstrated by strong writing, verbal and listening skills to create an open and transparent environment for the exchange of information. Moderately Skilled	Communicate Effectively – As demonstrated by strong writing, verbal and listening skills to create an open and transparent environment for the exchange of information. Highly Skilled
Inspire & Engage – As demonstrated by an ability to motivate loyalty to a mission or plan; challenge individuals professionally and personally to achieve goals; connect employees to the work; celebrate success.	Inspire & Engage – As demonstrated by an ability to motivate loyalty to a mission or plan; challenge individuals professionally and personally to achieve goals; connect employees to the work; celebrate success. Needs Improvement	Inspire & Engage – As demonstrated by an ability to motivate loyalty to a mission or plan; challenge individuals professionally and personally to achieve goals; connect employees to the work; celebrate success. Moderately Skilled	Inspire & Engage – As demonstrated by an ability to motivate loyalty to a mission or plan; challenge individuals professionally and personally to achieve goals; connect employees to the work; celebrate success. Highly Skilled
Develop Others – As demonstrated by a commitment to coach, guide, train, instruct, and develop team members; empowering others through a sense of shared ownership and decision-making; supporting work-life balance and employee wellbeing.	Develop Others – As demonstrated by a commitment to coach, guide, train, instruct, and develop team members; empowering others through a sense of shared ownership and decision-making; supporting work-life balance and employee wellbeing. Needs Improvement	Develop Others – As demonstrated by a commitment to coach, guide, train, instruct, and develop team members; empowering others through a sense of shared ownership and decision-making; supporting work-life balance and employee wellbeing. Moderately Skilled	Develop Others – As demonstrated by a commitment to coach, guide, train, instruct, and develop team members; empowering others through a sense of shared ownership and decision-making; supporting work-life balance and employee wellbeing. Highly Skilled
Foster a Team Environment – As demonstrated through the support and recognition of team members both professionally and personally; team oriented.	Foster a Team Environment – As demonstrated through the support and recognition of team members both professionally and personally; team oriented. Needs Improvement	Foster a Team Environment – As demonstrated through the support and recognition of team members both professionally and personally; team oriented. Moderately Skilled	Foster a Team Environment – As demonstrated through the support and recognition of team members both professionally and personally; team oriented. Highly Skilled
Exhibit Personal Credibility – As demonstrated by authenticity, confidence, consistency, courage, decisiveness, generosity, honesty, integrity, judgment and risk awareness.	Exhibit Personal Credibility – As demonstrated by authenticity, confidence, consistency, courage, decisiveness, generosity, honesty, integrity, judgment and risk awareness. Needs Improvement	Exhibit Personal Credibility – As demonstrated by authenticity, confidence, consistency, courage, decisiveness, generosity, honesty, integrity, judgment and risk awareness. Moderately Skilled	Exhibit Personal Credibility – As demonstrated by authenticity, confidence, consistency, courage, decisiveness, generosity, honesty, integrity, judgment and risk awareness. Highly Skilled
Build Collaborative Relationships – As demonstrated by a broad appreciation for collaboration in public policy engagement and fostering an inclusive environment for consensus-building and decision-making.	Build Collaborative Relationships – As demonstrated by a broad appreciation for collaboration in public policy engagement and fostering an inclusive environment for consensus-building and decision-making. Needs Improvement	Build Collaborative Relationships – As demonstrated by a broad appreciation for collaboration in public policy engagement and fostering an inclusive environment for consensus-building and decision-making. Moderately Skilled	Build Collaborative Relationships – As demonstrated by a broad appreciation for collaboration in public policy engagement and fostering an inclusive environment for consensus-building and decision-making. Highly Skilled
Improve Our Organization – As demonstrated by a commitment to drive continuous improvement for better results.	Improve Our Organization – As demonstrated by a commitment to drive continuous improvement for better results. Needs Improvement	Improve Our Organization – As demonstrated by a commitment to drive continuous improvement for better results. Moderately Skilled	Improve Our Organization – As demonstrated by a commitment to drive continuous improvement for better results. Highly Skilled
Achieve Results – As demonstrated by setting a clear vision to achieve productive results by developing plans to meet targets, leverage staff skills and solve problems.	Achieve Results – As demonstrated by setting a clear vision to achieve productive results by developing plans to meet targets, leverage staff skills and solve problems. Needs Improvement	Achieve Results – As demonstrated by setting a clear vision to achieve productive results by developing plans to meet targets, leverage staff skills and solve problems. Moderately Skilled	Achieve Results – As demonstrated by setting a clear vision to achieve productive results by developing plans to meet targets, leverage staff skills and solve problems. Highly Skilled
Model Good Governance – As demonstrated by stewardship for customer service, accountability, transparency, sustainability, policy, compliance and solid political acumen.	Model Good Governance – As demonstrated by stewardship for customer service, accountability, transparency, sustainability, policy, compliance and solid political acumen. Needs Improvement	Model Good Governance – As demonstrated by stewardship for customer service, accountability, transparency, sustainability, policy, compliance and solid political acumen. Moderately Skilled	Model Good Governance – As demonstrated by stewardship for customer service, accountability, transparency, sustainability, policy, compliance and solid political acumen. Highly Skilled

Question Title

* 7. Rank Your Interest in the Cal-IPGCA Innovation Priorities (IPs):
There are 6 Innovation Teams, of 12 members each, representing each IP. Teams will be developed to combine the most balanced spectrum of workforce composition, skill and interest. NOTE: In assessing interest, please balance your knowledge alongside your personal/professional interest in this innovation priority.

	Not Interested	Somewhat Interested	Very Interested
Cultivating Risk Intelligence in Government Operations	Cultivating Risk Intelligence in Government Operations Not Interested	Cultivating Risk Intelligence in Government Operations Somewhat Interested	Cultivating Risk Intelligence in Government Operations Very Interested
Digital Transformation and Upskilling the Workforce	Digital Transformation and Upskilling the Workforce Not Interested	Digital Transformation and Upskilling the Workforce Somewhat Interested	Digital Transformation and Upskilling the Workforce Very Interested
Users First: Embracing Innovation Without Fear	Users First: Embracing Innovation Without Fear Not Interested	Users First: Embracing Innovation Without Fear Somewhat Interested	Users First: Embracing Innovation Without Fear Very Interested
Managing Priorities Amidst Disaster	Managing Priorities Amidst Disaster Not Interested	Managing Priorities Amidst Disaster Somewhat Interested	Managing Priorities Amidst Disaster Very Interested
Meeting Citizen Needs: Back to the Center	Meeting Citizen Needs: Back to the Center Not Interested	Meeting Citizen Needs: Back to the Center Somewhat Interested	Meeting Citizen Needs: Back to the Center Very Interested
Transforming Silo Mentality	Transforming Silo Mentality Not Interested	Transforming Silo Mentality Somewhat Interested	Transforming Silo Mentality Very Interested

Question Title

* 8. I am submitting this application to be considered for the following opportunities:

As a full-time trainee: (62 Professional Development Hours @ $2850 Per Trainee.)

As a part-time, work-based trainee. (38 Professional Development Hours @ $495 per trainee.)

*As a part-time, work-based trainee. (38 Professional Development Hours. My registration is $Fee Waived as I am registering as a "work-based partner" for a registered Full-Time Cal-IPGCA Trainee.

As a Facilitation Assistant; e.g., one of 6 training positions under Cal-IPGCA 2018, at the rate of $2850 per trainee.

*Please provide the Name, Title, Department and email of the registered full-time Cal-IPGCA you support as a part-time registrant.

Question Title

* 9. If applying as a full-time trainee, are you electing to include the USC 360-degree professional development assessment + two-45 minute Executive Coaching Sessions?

Note: This represents an "add-on" fee of $550. This is a significantly discounted rate offered to Cal-IPGCA full-time trainees by USC.

Yes, please add the USC 360 Professional Development Assessment and Executive Coaching Package to my curriculum. (Your department will be invoiced for this service in conjunction with your training package.)

No, do not choose to elect this package.

Question Title

* 10. Explain why you want to be considered as a Cal-IPGCA Leader, Innovator and Change Agent trainee, (or Assistant Facilitator) for the 2018 Cohort.

Question Title

* 11. Additional Information Requested: Check all that apply.

I am a member of NXTGov.

I am a member of the Asian Pacific State Employees Association (APSEA).

Not applicable.

Question Title

* 1. Applicant - Agency-Department Information

Question Title

* 2. The scheduled training dates for Cal-IPGCA 2018 are listed below. Each training date is significant and unique. Please identify your availability for all training dates.

Question Title

* 3. How many years have you been employed by the State of California?

Question Title

* 4. Applicant's Direct Supervisor/Manager: (Note: The applicant's direct supervisor/manager will have an "audit only" seat to review the trainee's progress. The supervisor MUST approve the applicant's registration.)

Question Title

* 5. Status of Supervisor's/Manager's Awareness of this Submission:

Question Title

Question Title

Question Title

* 8. I am submitting this application to be considered for the following opportunities:

Question Title

Question Title

* 10. Explain why you want to be considered as a Cal-IPGCA Leader, Innovator and Change Agent trainee, (or Assistant Facilitator) for the 2018 Cohort.

Question Title

* 11. Additional Information Requested: Check all that apply.

Question Title

* 12. Should you have questions or comments, please identify in the space provided below.