THE 2015 RISE PROGRAMS ONLINE GUIDLINES The Public Health Leadership and Learning Undergraduate Student Success Program (PLLUSS)

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1 THE 2015 RISE PROGRAMS ONLINE GUIDLINES The Public Health Leadership and Learning Undergraduate Student Success Program (PLLUSS) Thank you for your interest in the Public Health Leadership and Learning Undergraduate Student Success Program (PLLUSS). THIS IS A SAMPLE APPLICATION PACKET. IMPORTANT: Please review the instructions before beginning the online application. You MUST complete the entire application in one session. This form will NOT save. The SAVE button's only function is to submit the completed application to the program office. Navigate the form (move from field to field) by hitting the tab button (if you hit the space bar all previously inputted data will be lost in cyberland!!) At the end of these instructions is the link to the PLLUSS Online Application. Please note that all applications must be completed using the RISE Programs Online Application. Applications submitted AFTER the deadline of January 31, 2015, 11:59PM EST will automatically be deleted from the database. Please note all applications are automatically dated and time stamped. If applying online poses a hardship, please contact our office during business hours before the closing date for an alternate submission method ( ). IMPORTANT: Be prepared to complete the application in one session, you will NOT be able to save the form and return to complete later; you can remain logged in for two (2) hours. Have all of your documents readily available and saved in the final formats. Many of the fields are required. The below instructions will help you prepare and complete the application. Before opening the application, please review the instructions and this SAMPLE application in detail. You will need to have the following information and electronic documents saved and accessible on the computer you will be using, to upload into the application or copy and paste into the application. Uploaded files should be in the following format and cannot exceed 25 MB: Resume (Word or PDF format): example: smith_joe_resume Unofficial Transcript (Word or PDF format): example: smith_joe_transcript Have the following items completed and saved in a word document so you can cut and paste into the online application each response is not to exceed 250 words: 1. The three (3) Short Answer Responses 2. The Essay Questions 1 and 2 (required)

2 Tooltips (hover your mouse over the question mark in the gray circle) will provide information on certain fields and questions. APPLICATION ACKNOWLEDGEMENT Section: Please type your full name in the field provided. Click Sign under the Signature Box. Use your cursor (or if you have a touch screen) sign your name in the box. Click Done, located below the signature box, when completed. 1) When you complete the application return to the top right column of the application and click Save Record; hitting Save Record will SUBMIT your application. If you forget to complete a section, hitting the Save Record button will notify you what required items are missing in the Record Save Checklist (right column). 2) Saving the Record may take a few seconds. Once completed you will be given the option to Close or Print. Please be prepared to print your application or change your print options and print to a PDF. 3) Again, you will NOT be able to save the form AND return to complete later. THE SAVE RECORD BUTTON SUBMITS COMPLETED APPLICATIONS TO THE PLLUSS PROGRAM OFFICE. For your tracking, you will receive the following automatic s (we recommend you save these s): A) A confirmation receipt upon submission of your application B) tification when your referee(s) have submitted a letter of recommendation to the PLLUSS program office. If you are ready to complete the PLLUSS Application_PLEASE RIGHT CLICK HERE TO BEGIN (Right click on the TEXT LINK and select Copy Hyperlink, then paste URL into one of the following Browsers: FireFox or Google CHROME). This link can also be found at This is NOT the Online Application this is a SAMPLE DOCUMENT

3 PLLUSS Application 2015 Instructions for the PLLUSS Online Application This application cannot be saved for later completion. Once you begin you must complete. The 'SAVE RECORD' button SUBMITS COMPLETED APPLICATIONS to the program office. Demographic Applicant Information *Date of Application 10/30/2014 *Name First Middle Last *Date of Birth MM/DD/YYYY *Local Address Address Line 1 Line 2 State Zip * customer_care@apricot.info *Phone: Local *Phone: Home Phone: Cell *Gender Female Male Other *Ethnicity Hispanic or Latino? (Other, please specify ethnicity) Other *Race (Please select the best description of your race) If requested, Please SPECIFY race details in the box below. 1/7

4 *Citizenship Status U.S. Citizen Permanent Resident U.S. National *Primary Language Spoken at Home English Spanish or Spanish Creole Chinese Tagalog French (including Patois, Cajun) Vietnamese German Korean Other *First generational college? *Pell Grant Eligible *I learned about the PLLUSS Program from: Permanent Residence *Permanent Residence Address Address Line 1 Line 2 State Zip Education and Focus *College/University *Minority Serving Institution Historically Black Colleges and Universities (HBCU) Hispanic-serving Asian-serving Tribal Colleges and Universities Other minority-serving t Applicable *Student Classification Sophomore Junior *Current Major Anthropology Biology/Biological Science 2/7

5 Business Chemistry Communications Computer Science Economics Education English Engineering Geography Health Education Health Sciences History International Relations Journalism Mathematics Marketing Neuroscience Nursing Pharmacy Psychology Political Science Pre-Dentistry Pre-Med Public Health Sociology Veterinary Medicine t Specified *My Highest Educational Goal Bachelor's Degree Master's Degree Doctorate/Professional Degree (e.g. MD, PhD, DrPH) *My future career area/field of study: *What is your future career focus and setting? (Please select a Career Focus and Career Setting. To select multiple items HOLD Ctrl and highlight choices. Select all that apply) Clinical Focus Public Health Focus Research Focus Academic Setting Administrative Setting *Anticipated Community Setting Graduation Date Education/Training Setting MM/DD/YYYY Federal/State/Local Agency Setting *GPA Federal Range (FQHC)/State/Local Health Department Setting National Health Organization Setting 3.0 to 3.4 n-profit Setting Private/For-Profit 3.5 to 4.0 Setting *Current Private Practice Grade Point Setting Average Other 0.0 *Summer Training Site Preferences (select the closest location to your permanent address or your research area of interest) Kennedy Krieger Institute/Johns Hopkins University, Baltimore, MD California State University-LA, Los Angeles, CA University of Cincinnati, Cincinnati, OH *Public Health Experience-- Please identify your public health experience by selecting one (1) of the categories. Exposure: I have little to no exposure to the field of public health and/or work on health disparities. Engagement: I am considering pursuit of public health in the context of another health-related discipline, i.e. MD, DO, RN, DDS, Social Work, etc. Enrichment: I am pursuing public health as a profession. 3/7

6 Housing *I need housing for the summer training site *I need housing for the orientation in Baltimore, MD *I need housing for the CDC seminar in Atlanta, Georgia *I will need parking information for the summer training site (Parking fees are not covered by the Program) Health-Insurance-Emergency Information *Health Insurance Carrier (enter t Applicable if none) Policy Number Subscribers Name *Emergency Contact Name *Emergency Address Address Line 1 Line 2 State Zip *Phone: Emergency Contact *If accepted, will you require special assistance If you require special assistance, please describe the support you will need tes Name of personal assistant, if applicable Please rank your top 3 research interests: 4/7

7 Adolescent Health Aging Cancer Disparity Cardiovascular Child Maltreatment/Community Violence Diabetes Disability Education HIV & Other Infectious Diseases Men's Health Issues Mental Health Nutrition/Obesity Substance Abuse Other research interest Short Answers--Please respond to each question in 250 words or less *Describe your past community service, leadership, and/or research experiences. (250 words or less) tes *How do you anticipate participating in the PLLUSS program will help your future career goals? (250 words or less) tes *List any achievements (i.e., honors or awards; 250 words or less) tes Essay Question 1--Please respond in 250 words or less *ESSAY NUMBER 1 (REQUIRED): Why is taking a public health approach important to achieve health equity? tes Essay Question 2--Please respond in 250 words or less *ESSAY NUMBER 2: (Research) What do you believe is (are) the most important public health issues(s)? Why did you choose this (these) issue(s) and how would you solve it (them)? tes 5/7

8 Resume *ATTACH FILE Choose File file chosen Up to 25 MB Unofficial Undergraduate Transcript *ATTACH Unofficial University Transcript--PLEASE NOTE AN OFFICIAL TRANSCRIPT IS REQUIRED UPON ACCEPTANCE. Please ensure the transcript includes your name and the school name. Choose File Up to 25 MB file chosen Letters of Recommendation Two letters of recommendation from faculty at your previous or current university are required. Upon submission (SAVE RECORD) of your application, an will automatically be sent to each Referee with instructions on how to submit a letter on your behalf. All letters must be uploaded on institutional letterhead using the electronic form provided to each referee. *Referee 1: Name First Middle Last *Referee 1 Suffix *Referee 1: Institution/Organization *Referee 1: customer_care@apricot.info *Referee 1: Phone *Referee 1: Fax *Referee 2: Name First Middle Last *Referee 2 Suffix *Referee 2: Institution/Organization *Referee 2: customer_care@apricot.info *Referee 2: Phone *Referee 2: Fax Consent *I agree to be contacted to help evaluate the need for summer public health leadership programs. Participation in an end of summer evaluation will include a drawing for a gift card. 6/7

9 Acknowledgement of My Application *Please type your full name and provide signature in the box using the cursor. By doing so you acknowledge that the information contained in this application is true and accurate to the best of your knowledge and that information may be summarized (without personal identifiers) and shared with the Federal Funding Agency, the Centers for Disease Control and Prevention. Name Full Name Signature To Submit your application To SUBMIT your application, click 'SAVE RECORD' top right column. By saving you will SUBMIT your application. 7/7