Apply to MAPH

Application Deadline: May 31, 2008

Applicants must be part of a three- to six-person team including at least one public health manager. All teams are encouraged to include a community partner, such as a local physician, social work manager, hospital administrator, or non-profit representative. If you have questions about team composition, please call or email us-- community partners will improve your selection chances!

To Apply:

EACH member of the team submits a separate application.
Send us a letter or email of support from your health director, agency director, or other appropriate sponsor of your team.
Fill out the following form and submit on-line. THANK YOU!

Items with marked * are required.

Your information
*First Name
MI
*Last Name
Job Title/Position
*Organization
*Work Mailing Address
*City
*State
*Zip Code
*Work Phone Number
Extension
Work Fax Number
*E-mail Address at Work
E-mail Address at Home
Highest academic degree(s) earned:
Where you work
Your Job Responsibilities
Number of people you supervise:
Years in public health or related field:
Years in supervisory position(s):
Approximate budget you manage:
Please check your preference:	Cohort starting Monday, July 28, 2008 Cohort starting Monday, August 4, 2008
*Date of Birth:
*Gender:	Male Female
Race or Ethnic Origin:
Supervisor (Health Director/Agency Director/Department Director) Information
Name:
Director Email:
Director Title:
Director Street Address:
City:
State:
Zip Code:
Work Phone Number:
Remember to ask your supervisor to send a letter or email of support!
Team Information
Names of other team members from your organization, plus community partner (each team member should submit their own application)
Member 1:
Member 2:
Member 3:
Member 4:
Member 5:
Proposed Business Plan Project
Brief description of your proposed Business Plan project, if you have one in mind already. Topic should be based on community needs and your organization's strategic plan. See Curriculum section for details; view past business plans and topics for ideas.

Admission to School of Public Health programs is without regard to race, sex, national origin, color, religion, handicap, age or veteran's status.

If you have any trouble with this form, please contact Becky Hart at 919-843-6612 or rmhart@email.unc.edu.

2:43