LANGSTON UNIVERSITY PUBLIC HEALTH PROGRAM. SCHOOL OF NURSING AND HEALTH PROFESSIONS Langston, Oklahoma APPLICATION PACKET

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1 LANGSTON UNIVERSITY SCHOOL OF NURSING AND HEALTH PROFESSIONS Langston, Oklahoma APPLICATION PACKET

2 MEMO To: Public Health Program Applicants From: Marshan Oliver-Marick, MPH, CHES Director, Public Health Program Subject: Application Procedures Please follow the guidelines below in order to apply to the Langston University Public Health Program. The following documentation, including the application form should be completed and submitted no later than March 1. Ø Official transcripts from all universities/colleges attended Ø Completed application form Ø Course work checklist Ø A statement of purpose and objectives Ø Two letters of reference (one of which should come from current/former instructor) o The letters should include information regarding the student s academic performance and goals Ø A resume/curriculum vitae Ø Two recommendation forms Only complete application/documentation will be reviewed. Ø Application due date: o Fall Semester: March 1 st All applicants must retain a copy of all materials submitted to the Public Health program. Your application must be received or postmarked on or before March 1 st to: Public Health Program Langston University School of Nursing and Health Professions Attn: Admission Committee 215 Allied Health Center, Langston, OK 73050

3 APPLICATION FORM PLEASE PRINT AND SIGN THE APPLICATION. Date: Student ID #: LAST NAME FISRT NAME MIDDLE NAME MAIDEN NAME Address while in school: Permanent Address: Street Apt/Home Number City State Zip Code Street Apt/Home Number City State Zip Code Home Phone: Work Phone: Emergency Contact (Please provide complete name and address : Phone: OK Resident? [ ] Yes [ ] No US Citizen? [ ] Yes [ ] No Other Citizenship: Place of Birth: College, universities or other schools attended: Institution City/State Date Attended Diploma/Degree Total College Credit Completed: Is English your second language? [ ] Yes [ ] No Signature:

4 COURSE WORK CHECKLIST To be completed by applicant and submitted with complete application Applicant Name: Date: COURSE TITLE English Comp I (EG 1113) CREDIT HOURS SEMESTER/YEAR TAKEN GRADE English Comp II (EG 1213) College Algebra (MT 1513) Intro to Information Processing (CS 1103) Personal and Social Development (PY 1111) US Government (PS 1113) Physical Science (NP 1113) Natural Science (Biological) (NB 1114) Intro to Psychology (PY 1113) US History (HT 1483) Introduction to Nutrition (FCS 2123) Technical Writing (EG2053) Elementary Statistics (MT 2013) General Education Elective Introduction to Speech (EG 2053) Survey of Western Humanities (HU 2103) Intro to Global Health (PUH 2313)

5 RECOMMENDATION FORM Two recommendations are required in order to complete your application. At least one recommendation should come from a former or current instructor. 1. To be completed by Applicant Please complete this portion before submitting to evaluator. This form is required in order to complete your application. [ ] I waive my right to view the contents of this recommendation form. I understand that my decision to waive my right to review the evaluator comments submitted on this form will not affect the decision of the Admission Committee. [ ] I do not waive my right to view the contents of this recommendation form. I understand that my decision to review the evaluator s comments will not affect the decision of the Admission Committee. LAST NAME FISRT NAME MIDDLE NAME MAIDEN NAME Date: Signature: 2. To be completed by the Recommender The person named above is applying for admission to the Public Health Program at Langston University. Please complete this portion of the form. Thank you. Relationship to the applicant: [ ] Teacher [ ] Supervisor [ ] Academic Advisor [ ] Other (please specify) How long have you known the applicant? How would you rate, by checking (X) the box that corresponds to the applicant s attributes: Attributes Below Average Average Above Average Outstanding Academic Skills Writing Skills Verbal Communication Skills Interpersonal Skills Character/Integrity Comments (optional, you may use additional paper, if necessary) Recommender Name: Date: Contact (Phone or ) Please submit this form to emgodwin@langston.edu OR to: Langston University School of Nursing and Health Professions/Attn: Admission Committee/ Public Health Program/ 215 Allied Health Center, Langston, OK 73050