Mph Application for Hea650 - Applied Learning Experience Ii

MPH APPLICATION FOR HEA650 - APPLIED LEARNING EXPERIENCE II

Date of Application: ______MPH Track: COMMUNITY HEALTH

Instructions: Please complete this form and return it to your Applied Learning Experience Faculty Advisor at start of Applied Learning Experience II. All core and track courses need to be completed at the start of Applied Learning Experience II with a cumulative GPA of 3.00. Attach a current copy of student transcript to this form.
STUDENT INFORMATION
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Student I.D. Number: Click here to enter text.
Address: Click here to enter text.
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Cell Phone: Click here to enter text. / PLACEMENT SITE INFORMATION
Site Supervisor: Click here to enter text.
Placement Site: Click here to enter text.
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Scheduled Start Date for Applied Learning Experience II: Click here to enter a date.
COMPLETED MPH CORE COURSES

Semester Year

Course Credits Completed Completed Grade

HEA520 Public Health Epidemiology 3 Fall/Spring

HEA526 Biostatistics for Public Health 3 Fall/Spring

ENV530 General Environmental Health 3 Fall/Spring

HEA516 Health Care Management 3 Fall/Spring

HEA632 Social and Behavioral Aspects of Health 3 Fall/Spring

HEA648 Research Methods in Public Health 3 Fall/Spring

COMPLETED COMMUNITY HEALTH TRACK COURSES

Semester Year

Course Credits Completed Completed Grade

HEA531 Community as a Basis for Health 3 Fall

HEA543 Transcultural Health 3 Fall

HEA539 Health Promotion Program Planning 3 Spring

HEA538 Evaluation of Health Programs 3 Spring

HEA544 Program Admin. Health/Human Service 3 Summer/Winter

HEA645 Global Community Health Promotion 3 Fall/Spring/Sum

HEAHealth Elective:Click here to enter text. 3 Fall/Spring/Sum

HEA649 Applied Learning Experience I 3 Fall/Spring/Sum

TOTAL NUMBER OF CREDITS AT THE START OF APPLIED LEARNING EXPERIENCE II :
(A total of 42 MPH course credits is required before the start of Applied Learning Experience II)
Cumulative GPA at start of Applied Learning
Experience II:
Approval to start Applied Learning Experience II:
Date of Approval: ______
Denied approval: (If student is denied approval
provide reasons in advisor comment section).
Date of Denial: ______
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Applied Learning Experience Faculty Advisor
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Student Applicant / Advisor’s Comments:
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