DrPH. Graduate Program in Public Health Doctor of Public Health Application for Admission

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1 DrPH MaMast Graduate Program in Public Health Doctor of Public Health Application for Admission Dilyayev 6/2008

2 M am ast Graduate Program in Public Health 450 Clarkson Avenue, Brooklyn, NY Phone (718) Fax: (718) Doctor of Public Health Application Guidelines Review these guidelines and make certain that you understand them for they are designed to assist you in presenting the strongest and most timely application possible. An application must be completed with all supporting documentation before the Admissions Committee can review it. A completed application file includes: Completed and signed application, including personal statement. Supporting Documents: One official transcript(s) for all course work completed Official copies of required test score(s) Three completed and signed Applicant Recommendation Forms $45.00 non-refundable Application Fee (check or money order) Signed Applicant s Checklist form The completed application should be sent to: SUNY Downstate Medical Center Office of Admissions 450 Clarkson Avenue, Box 60 Brooklyn, New York IMPORTANT NOTES: Applications that are completed with all required supporting documentation and received by February 15th for the Summer semester and April 15 th for the Fall semester -- will be given high priority. Applicants will be notified of their admission decision within eight weeks after the deadline. Applicant Dos: DO use the application checklist to ensure that you have enclosed and submitted all the appropriate materials to the SUNY Downstate Medical Center Office of Admissions. DO enclose the application fee with the application packet. DO make certain that materials are legible and easy to read. Whenever possible, type your application and accompanying documents. DO call the GPPH office at if you are unclear about any aspect of the admissions process. 2

3 DO make sure that you have arranged to take the GRE, MCAT, GMAT, LSAT, DAT, or OAT well before the Summer and Fall application deadlines so that your application can be processed in a timely manner. Be sure to have scores sent directly to the SUNY Downstate Admissions Office. DO choose recommenders whom you believe will represent you well those who can speak to your abilities and your interests or experiences in public health. Make certain that your recommenders understand the need to be specific in addressing your strengths, skills, qualifications, and background. A letter from each recommender, in addition to a completed recommendation form, is often helpful in providing information about you. Applicant Do Nots: DO NOT assume that your GRE, MCAT, GMAT, LSAT, DAT, or OAT scores will be sent from the testing service if you have not received confirmation from the service. Follow up and make certain the scores have been sent. DO NOT assume that your application has arrived by the deadline. Contact the Office of Admissions to check the status by or call: DO NOT ask for recommendations from people who do not know you in an academic or professional capacity. Personal recommendations written by friends or family, which do not address your ability in an academic or professional capacity, will not be considered. DO NOT forget that you must indicate why you are interested in obtaining a degree in public health in your personal statement. DO NOT be dismayed by the public health essay if you are not a public health professional. The Admissions Committee is interested in how you problem solve and express your ideas in writing. TRANSCRIPT GUIDELINES One official transcript, i.e. documents with the registrar s/ university school seal sent in the University s sealed envelope, must be received from each post-secondary (after high school) academic institution attended regardless of length of enrollment or credit granted. This includes, but is not limited to, summer classes, study abroad courses, medical school records, post baccalaureate courses and coursework towards advanced degrees. Only applications with official transcripts on file will be reviewed for an admission decision. **Applicants who require additional evaluation, i.e. applicants who have completed more than one year of college level course work outside the USA, must request a course-by-course evaluation by an agency accredited by the NATIONAL ASSOCIATION OF CREDENTIAL EVALUATION SERVICES (NACES). These requests should be done and completed well in advance of the summer and fall semester deadlines. A list of accredited course evaluation agencies can be found on the SUNY Downstate Graduate Program in Public Health website 3

4 APPLICANT EVALUATION FORMS Applicants must submit three letters of recommendation. Please complete your portion of the Applicant Evaluation Form and be sure to include your name and address on the enclosed envelope. Forward these forms as soon as possible to the individuals you have listed on your application form. Recommenders might include, but are not limited to the following: 1. an undergraduate or graduate school advisor 2. an employer/supervisor 3. an instructor in your major field 4. a professional colleague Please ensure that the individuals you have selected return the recommendation directly to you or the Office of Admissions, in a sealed envelope with the recommender s signature across the seal. 4

5 M am ast Graduate Program in Public Health 450 Clarkson Avenue, Brooklyn, NY Phone (718) Fax: (718) Doctor of Public Health Application for Admission Application fee: $45 I am applying for admission for: Summer Fall Year 20 Application deadline for Summer: February 15th; for Fall: April 15 th Please indicate program of interest: [ ] Community Health Sciences (CHSC) [ ] Environmental & Occupational Health Sciences (EOHS) [ ] Epidemiology (EPID) [ ] Health Policy and Management (HPMG) IDENTIFICATION INFORMATION (LAST NAME) (FIRST NAME) (MIDDLE INITIAL) (JR, III, ETC.) If you have worked or have educational records under a different name, please give former name(s) Social Security Number (Optional) Date of Birth Sex: [ ] Female [ ] Male Month/Date/Year Mailing Address (NUMBER AND STREET) (APT. #) (CITY) (STATE) (ZIP CODE) (COUNTRY, If other than US) Home Telephone Business Telephone Cell Phone address **Must Complete** How often do you check your ? Permanent Address (if different from above) (NUMBER AND STREET) (CITY) (STATE) (ZIP CODE) (COUNTRY, If other than US) CITIZENSHIP/RESIDENCY INFORMATION (Priority will be given to U.S. citizens or Permanent Residents) Place of Birth: Current Status: [ ] U.S. Citizen [ ] Permanent Resident (provide copy of card) [ ] Temporary visa holder, specify visa category (F-1, H-1, etc.) (attach a copy of immigration document) PLEASE NOTE: If you are a permanent resident or temporary visa holder, a copy of your alien registration card or visa must be submitted with your application. Are you a New York State resident (for tuition purposes)? [ ] Yes [ ] No The definition of a New York State resident for tuition purposes appears in the Office of Admissions section of the website 5

6 If you wish to identify yourself as a member of an ethnic/racial group, please indicate: [ ] African-American, Non-Hispanic [ ] Caucasian [ ] Hispanic/Latino [ ] Asian [ ] Native American/Alaskan Native [ ] Native Hawaiian/Pacific Islander [ ] Other EDUCATIONAL HISTORY Beginning with the most recent, list in chronological order ALL undergraduate and graduate institutions attended, regardless of how long ago you attended. You must submit official transcripts for all institutions listed. Applicants educated abroad must submit an educational credentials evaluation. University/College City/State Dates of Attendance (Month/Year) # of Credits Completed/ In Progress Overall GPA Field of Study (Major & Minor) Degree & Date Have you ever withdrawn from an institution, been terminated or disciplined for academic performance or conduct violation? [ ] Yes [ ] No If Yes, please attach a sheet with an explanation. TESTING INFORMATION Which exam(s) have you taken or plan to take? (Please forward official text scores with your application) Name of Exam Date Taken/Planned Total Score Verbal Score Verbal % Quantitative Score Quantitative % Analytical Score Graduate Record Exam (GRE) Medical College Admission Test (MCAT) Verbal Score: Bio Sci Score: Phy Sci: Dental Admission Test (DAT) Graduate Management Admission Test (GMAT) Law School Admission Test (LSAT) Optometry Admission Test (OAT) Other: [ ] Test of English as a Foreign Language (TOEFL) Date taken/planned Analytical % [ ] Internet-based exam score: [ ] Computer-based exam score: [ ] Paper-based exam: If you are already a MD, have you taken and passed Step 1 and 2, USMLE? [ ] Yes [ ] No PLEASE NOTE: Official examination results must be submitted directly to the Office of Admissions no later than the following deadlines: February 15 th for Summer semester and April 15 th for Fall semester. If you are a foreign Medical School graduate, do you have ECFMG certification? [ ] Yes (If yes, please submit a copy of the certification) [ ] No 6

7 MEDICAL REGISTRATION INFORMATION If you are a registered (Dentist, Nurse, Occupational Therapist, Physician, Physician Assistant or Other), list state(s) in which you are licensed. Please Note: A copy of your New York State license must be attached to your application. State Registration Number State Registration Number EMPLOYMENT HISTORY (List most recent position first) Please Note: Curriculum Vitae may be attached to the application in lieu of completing this section. Dates (from/to) Employer City State Title No. of hrs/week (If part-time) Please indicate if you are currently employed as: [ ] Physician [ ] Physician (Fellow) [ ] Physician (Resident) [ ] Nurse [ ] Nurse Practitioner [ ] Physician Assistant [ ] Other health professional (specify occupational title): Military Experience: Date of Entry Date of Discharge Branch of Service Highest Rank Months of Active Duty Type of Duty HEALTH RELATED EXPERIENCES (List most recent first) Dates of Service (from/to) Name of Agency, Employer or Organization and Address Supervisor s Name and Phone Number Volunteer/Paid (P or V) Number of Hours Of Service Provided 7

8 REFERENCES (Refer to the Application Instructions for listing references) Last Name First Name Title Organization, Hospital or School Last Name First Name Title Organization, Hospital or School Last Name First Name Title Organization, Hospital or School ADDITIONAL INFORMATION List any honors you received while in college (include honorary societies): (List most recent first) Name of award/distinction Sponsoring Organization Year received or awarded Brief description of award List extracurricular activities in which you participated while in college (include offices held): List any community activities in which you have participated: Are you presently a full-time student? [ ] Yes [ ] No If NO, please describe your current activities if you are not employed full-time: Have you ever been convicted of a felony or a misdemeanor? [ ] Yes If YES, please attach a sheet with an explanation. If you served in the military, were honorably discharged? [ ] Yes If NO, please attach a sheet with an explanation. [ ] No [ ] No APPLICANT S SIGNATURE I have read and understand the Admissions Brochure instructions. I certify that the information submitted in this application and associated material is complete, accurate and correct to the best of my knowledge. Applicant Signature Date Admission to SUNY Downstate Medical Center is based on the qualifications of the applicant. SUNY Downstate Medical Center does not discriminate on the basis of race, sex, color, creed, age, national origin, disability, sexual orientation, religion, marital status or status as a disabled veteran in the Vietnam era. Responses on this application to questions of race, sex, and date of birth are voluntary and are used for statistical purposes only. PLEASE MAKE CERTAIN YOU READ AND RESPOND TO THE REQUIRED STATEMENTS (PERSONAL STATEMENT AND ESSAY) ON THE FOLLOWING TWO PAGES. 8

9 M am ast Graduate Program in Public Health 450 Clarkson Avenue, Brooklyn, NY Phone (718) Fax: (718) WRITING REQUIREMENTS FOR APPLICATION TO THE GRADUATE PROGRAM IN PUBLIC HEALTH. Applicant-prepared written materials provide a more complete picture of an individual s problem solving and writing skills, as well as an opportunity for the applicant to present her or his public health strengths. As such, the Committee on Admissions requires each applicant to complete a personal statement. The writing assignment should be typed and 300 words or less. PERSONAL STATEMENT An essay of 300 words or less denoting the applicant s interest in pursuing a doctoral degree in a specific area. The applicant should examine the research and practice interests of the doctoral faculty in his/her respective areas of interest to ensure that an appropriate faculty collaboration is possible. Please see the Downstate website to learn more about the respective faculty. Please use separate sheets of paper for your personal statement, number the pages, and make certain that you include your name on each sheet. 9

10 M am ast Graduate Program in Public Health 450 Clarkson Avenue, Brooklyn, NY Phone (718) Fax: (718) LETTER OF RECOMMENDATION (Applicant Please Print) If you have educational records under a different name, give your former name(s) (LAST NAME) (FIRST NAME) (MIDDLE INITIAL) (JR., III, ETC) Date of Birth Sex: [ ] Female [ ] Male Please indicate program of interest: [ ] Community Health Sciences (CHSC) [ ] Environmental & Occupational Health Sciences (EOHS) [ ] Epidemiology (EPID) [ ] Health Policy and Management (HPMG) Applicant: In accordance with the provision of the Family Education Rights to Privacy Act of 1974(Public Law ), I understand that I have the right of access to this reference but may choose to waive that right. My preference is noted below. I hereby Waive Do not waive my right of access to the attached letter of recommendation. Signature of Applicant Date (NOTE: If you waive the right of access to review this letter of recommendation it will remain confidential.) TO THE RECOMMENDER The person whose name appears above is applying for admission to the SUNY Downstate Medical Center Graduate Program in Public Health for a DrPH Program in an area checked above. The Office of Admissions seeks your opinion regarding the applicant and your judgment regarding the applicant s ability to successfully complete advanced study in this field. Please know that your help is appreciated and that the Admissions Committee will give your recommendation. 1. Nature of relationship with applicant? Professor/Teacher Advisor Employer/Supervisor Other 2. If you have received a public health degree, please answer the following two questions. a) Public Health School/Program from you which you graduated: b) Degree received and Department: 3. How long have you known the applicant? Less than one year 1-3 years 3-5 years more than 5 years 4. How well do you know the applicant? Very well Moderately Minimally Not at all 5. Please assess the applicant compared to other students or employees whom you have known in a similar capacity. Academic Performance Intellectual ability Motivation for proposed field of study Oral communication Written communication Interpersonal skills Integrity Maturity Leadership skills Overall evaluation as an applicant for graduate study Outstanding (Top 5%) Superior (Top 10%) Good (Top 1/3) Fair (Middle 1/3) Poor (Bottom 1/3) Not Observed Continued on other side 10

11 Recommendation concerning admission: I recommend this applicant with enthusiasm I recommend this applicant with confidence I recommend this applicant I recommend this applicant, but with some reservations I am not able to recommend this applicant A narrative description or letter of the applicant s strengths and weakness is most helpful. Use a separate sheet if desired. Name of Recommender Title Signature Organization Address Description of applicant s strengths, weaknesses, and capacity for graduate study. Signature of Recommender: Date: 11

12 M am ast Graduate Program in Public Health 450 Clarkson Avenue, Brooklyn, NY Phone (718) Fax: (718) LETTER OF RECOMMENDATION (Applicant Please Print) If you have educational records under a different name, give your former name(s) (LAST NAME) (FIRST NAME) (MIDDLE INITIAL) (JR., III, ETC) Date of Birth Sex: [ ] Female [ ] Male Please indicate program of interest: [ ] Community Health Sciences (CHSC) [ ] Environmental & Occupational Health Sciences (EOHS) [ ] Epidemiology (EPID) [ ] Health Policy and Management (HPMG) Applicant: In accordance with the provision of the Family Education Rights to Privacy Act of 1974(Public Law ), I understand that I have the right of access to this reference but may choose to waive that right. My preference is noted below. I hereby Waive Do not waive my right of access to the attached letter of recommendation. Signature of Applicant Date (NOTE: If you waive the right of access to review this letter of recommendation it will remain confidential.) TO THE RECOMMENDER The person whose name appears above is applying for admission to the SUNY Downstate Medical Center Graduate Program in Public Health for a DrPH Program in an area checked above. The Office of Admissions seeks your opinion regarding the applicant and your judgment regarding the applicant s ability to successfully complete advanced study in this field. Please know that your help is appreciated and that the Admissions Committee will give your recommendation. 1. Nature of relationship with applicant? Professor/Teacher Advisor Employer/Supervisor Other 2. If you have received a public health degree, please answer the following two questions. a) Public Health School/Program from you which you graduated: b) Degree received and Department: 3. How long have you known the applicant? Less than one year 1-3 years 3-5 years more than 5 years 4. How well do you know the applicant? Very well Moderately Minimally Not at all 5. Please assess the applicant compared to other students or employees whom you have known in a similar capacity. Academic Performance Intellectual ability Motivation for proposed field of study Oral communication Written communication Interpersonal skills Integrity Maturity Leadership skills Overall evaluation as an applicant for graduate study Outstanding (Top 5%) Superior (Top 10%) Good (Top 1/3) Fair (Middle 1/3) Poor (Bottom 1/3) Not Observed Continued on other side 12

13 Recommendation concerning admission: I recommend this applicant with enthusiasm I recommend this applicant with confidence I recommend this applicant I recommend this applicant, but with some reservations I am not able to recommend this applicant A narrative description or letter of the applicant s strengths and weakness is most helpful. Use a separate sheet if desired. Name of Recommender Title Signature Organization Address Description of applicant s strengths, weaknesses, and capacity for graduate study. Signature of Recommender: Date: 13

14 M am ast Graduate Program in Public Health 450 Clarkson Avenue, Brooklyn, NY Phone (718) Fax: (718) LETTER OF RECOMMENDATION (Applicant Please Print) If you have educational records under a different name, give your former name(s) (LAST NAME) (FIRST NAME) (MIDDLE INITIAL) (JR., III, ETC) Date of Birth Sex: [ ] Female [ ] Male Please indicate program of interest: [ ] Community Health Sciences (CHSC) [ ] Environmental & Occupational Health Sciences (EOHS) [ ] Epidemiology (EPID) [ ] Health Policy and Management (HPMG) Applicant: In accordance with the provision of the Family Education Rights to Privacy Act of 1974(Public Law ), I understand that I have the right of access to this reference but may choose to waive that right. My preference is noted below. I hereby Waive Do not waive my right of access to the attached letter of recommendation. Signature of Applicant Date (NOTE: If you waive the right of access to review this letter of recommendation it will remain confidential). TO THE RECOMMENDER The person whose name appears above is applying for admission to the SUNY Downstate Medical Center Graduate Program in Public Health for a DrPH Program in an area checked above. The Office of Admissions seeks your opinion regarding the applicant and your judgment regarding the applicant s ability to successfully complete advanced study in this field. Please know that your help is appreciated and that the Admissions Committee will give your recommendation. 1. Nature of relationship with applicant? Professor/Teacher Advisor Employer/Supervisor Other 2. If you have received a public health degree, please answer the following two questions. a) Public Health School/Program from you which you graduated: b) Degree received and Department: 3. How long have you known the applicant? Less than one year 1-3 years 3-5 years more than 5 years 4. How well do you know the applicant? Very well Moderately Minimally Not at all 5. Please assess the applicant compared to other students or employees whom you have known in a similar capacity. Academic Performance Intellectual ability Motivation for proposed field of study Oral communication Written communication Interpersonal skills Integrity Maturity Leadership skills Overall evaluation as an applicant for graduate study Outstanding (Top 5%) Superior (Top 10%) Good (Top 1/3) Fair (Middle 1/3) Poor (Bottom 1/3) Not Observed Continued on other side 14

15 Recommendation concerning admission: I recommend this applicant with enthusiasm I recommend this applicant with confidence I recommend this applicant I recommend this applicant, but with some reservations I am not able to recommend this applicant A narrative description or letter of the applicant s strengths and weakness is most helpful. Use a separate sheet if desired. Name of Recommender Title Signature Organization Address Description of applicant s strengths, weaknesses, and capacity for graduate study. Signature of Recommender: Date: 15

16 M am ast Graduate Program in Public Health 450 Clarkson Avenue, Brooklyn, NY Phone (718) Fax: (718) Applicant s Checklist Dear Graduate Program in Public Health, I have read all applicable instructions and am submitting a complete application. The following items are enclosed. A fully completed and signed Application Form with the personal statement. Original transcripts in university sealed envelopes from each post-secondary academic institution attended, regardless of length of enrollment. Originals/photocopies of required test score report(s), which meet the requirement for the Graduate Program in Public Health. (eg. GRE, MCAT, GMAT, LSAT, DAT, or OAT scores) Three Applicant Evaluation Forms in sealed envelopes with the recommenders original signatures on the recommendation forms and/or letters and across the envelope seals. A check or money order for $45, payable to SUNY DOWNSTATE Medical Center. In addition, it is my responsibility to ensure that the following are forwarded to and received by the Office of Admissions: Official required test score report(s). A final transcript verifying the completion of all Bachelor s, Master s or Doctorate degree(s) (if applicable). Recommendation letters. ADDITIONAL QUESTION: Where/how did you hear about the Graduate Program in Public Health at SUNY Downstate Medical Center?. I am enclosing this checklist with my completed application. If you need further information, please contact me at ( ) - or by at: Sincerely, Applicant Signature Date 16

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