For Entry to the Postgraduate

APPLICATION FORM

for entry to the postgraduate

DIPLOMA & CERTIFICATE

IN PUBLIC HEALTH (DPH/CPH)

At the

University of Otago, Wellington

Te Whare Wānanga o Otāgo, Te Whanga-nui-a-Tara

Name of applicant: ______

Student ID No: (if known) ______

Date of application: ______

Due dates for receipt of applications:

First Semester 2014: 17 January 2014

Second Semester 2014:6 June 2014

PLEASE NOTE: Course papers cannot be changed within three weeks of the start of the semester.

NB: If you are not a New Zealand Citizen or Resident you must enrol as an International Student. Prospective International Students must apply to the International Office for admission to study at the University of Otago before submitting this form.

Information:

Contact:

Please complete pages 2 - 8 by completing the spaces provided and ticking appropriate boxes

Sign page 8

Return application together with your essay to:

Kate Geany

Postgraduate Administrator

Department of Public Health

University of Otago, Wellington

PO Box 7343

Wellington South 6242

If you have any queries, please phone Kate Geany on

(04) 918 6040

Or email:

Personal Information

Name: ______

Mr/Mrs/Ms/Miss/DrFirst NamesLast Name

Address:______

______

Gender:⁪male⁪female

D.O.B:______

Telephone:______(work)______(home)

Cellphone:______

Email:______

Are you a New Zealand College of Public Health Medicine registrar?

⁪yes⁪no

NB: Please check closing dates for application at:

Do you consent to your email address being made available to other Public Health students if requested?

⁪yes⁪no

Are you currently in paid employmnet?

⁪yes, full-time⁪yes, part-time⁪no

Do you have your employer’s consent to participate in the DPH Programme?

⁪yes⁪no

Citizenship status:

New Zealand Citizen Permanent residentInternational student*

other - please specify ______

Applicants who are not New Zealand residents must contact the International Office at

before submitting this application.

Which ethnic group do you belong to?

Mark the space or spaces that apply to you.

New Zealand European

Māori

Samoan

Cook Island Māori

Tongan

Niuean

Chinese

Indian

other (such as Dutch, Japanese,

Tokealuan). Please state:

______

Tertiary Qualifications

Please indicate all university degrees or diplomas, or other tertiary qualifications (e.g.certified nurse, polytechnic diploma) which you have gained in the table below. A general requirement for entry into postgraduate public health courses is a good undergraduate degree, diploma, or professional qualification, which would normally equate to a B average overall. Note also any qualification you expect to gain in 2013.

Degree, diploma, or other course / Institution / Country / Year of graduation
Awaiting Results:

English Language

Graduates from a non-New Zealand University, whose first language is not English, are required to show evidence of adequate proficiency in English. The IELTS score for University of Otago Postgraduate papers in Public Health is 7.5

My IELTS results are attached ⁪yes⁪no*

*Please explain______

Employment History

Please give details of your employment experience (starting with your most recent employment):

Personal Introduction

Applicants for DPH, DPH & CoP (physician training exempt), please write a short (300 to 500 word) introduction which outlines your interest & experience (as appropriate) in public health and a main reason for wanting to do postgraduate study (eg. Professional advancement, new direction, support for other interests etc.). Please type and attach to this form.

Course Plans

Which qualification are you enrollng for?

□Diploma of Public Health, DPH□full-time□part-time

(Consists of four papers of which two are compulsory)

□Endorsed Certificate of Public Health, CPH

(Consists of any two DPH papers with endorsed option)

Endorsement______

Refer list on following web site link:

□Certificate of Proficiency, CoP1:

(one paper only)

□one paper as part of a qualification from another university (eg. Massey MA, Victoria MDevSt)

Please specify______

______

□a Public Health paper as part of another Otago qualification

Please specify______

(e.g. MHealSc, MSc)

When do you plan to start?

Year:______Semester:______

MPH Plans

Students may proceed to MPH after completing the DPH with an average mark of at least 73% ( the equivalent mid B and B+ grades)

Would you be interested in proceeding to MPH? □yes□no□not sure

MPH applications are on a separate form. This can be submitted once you know your marks. (see our website for procedure to progress to MPH)

1This is awarded to a single paper which can stand alone or be converted retrospectively to become part of another qualification. It is also awarded for an Otago paper which is part of a qualification at another university.

Planned DPH/MPH papers

Please indicate your desired course in the table below by ticking the approproate cells. If you are not sure which paper to take indicate your choice with a query(?).

Notes:

An interview may be required before course approval is granted.
Two papers are considered a full-time course for a semester. There are two semesters in a full year.
All DPH students must take PUBH701 (Epidemiology and Biostatistics) and PUBH702 (Society, Health and Public Policy), plus TWO other PUBH papers from the list (one approved substitution is possible on application).
Full-time students take PUBH701 and one other paper in the first semester, and PUBH702 and one other paper in the second semester.
Part-time students take one paper each semester, for each of two years. Part-time students are advised to take PUBH 701 and PUBH702 in their first year (unless they are being considered for ad eundem entry to the course after successful completion of any ONE paper).
Students planning to enrol for MPH by dissertation will take SIX papers (4 DPH & 2 MPH) in total.

Paper / Description / 2014 / 2015

Semester 1

PUBH 701 / Epidemiology and Biostatistics (compulsory)
PUBH 705 / Health Promotion
PUBH 706 / Health Systems
PUBH 708 / Social Research Methods
PUBX 710
(Distance taught) / Public Health Law and Public Health Ethics

Semester 2

PUBH 702 / Society, Health and Public Policy (compulsory)
PUBH 703 / Health and Environment
PUBH 704 / Health Economics
PUBH 709 / Hauora: Maori Health Issues
PUBH 721 (15 points) / Advanced Epidemiology

PLEASE NOTE the compulsory papers (PUBH701 and PUBH702) are at times over subscribed so if you delay enrolment in these until late in the preceding semester you may not be able to proceed.

Substitute papers must be approved by the Public Health Board of Studies as having relevance to health and no significant overlap with another qualification.

There are two requirements for enrolment:

You must submit this application to the address or email on page 2 to study in Wellington

You MUST register with the University of Otago at :-

(Please indicate if completed on line)□

Final date for Semester One registration is 17 January 2014, otherwise you may incur a late fee.

N.B: To gain access to the Medical Library, Blackboard or other electronic resources you will need an ID card. Please remember to apply for your ID Card at the same time as your registration.

Signature of student:______

Date:______Otago ID No:______

(if already studied at Otago)

Please let us know where you heard about the DPH/CPH/MPH programme?

Have you ever taken part in any of the University of Otago Wellington Summer School short courses (preparatory, extension & professional development topics)?

(see

If yes please name the course(s)______