Tulane University APPLICATION FOR ADMISSION Public Health In Cuba May 27 June 7, 2013

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1 Tulane University A. All application materials must be submitted to the following address no later than 5:00pm on April 30, 2013: Alison Rinehart Department of Global Health Systems and Development Tulane School of Public Health and Tropical Medicine 1440 Canal Street, Suite 1900 New Orleans, LA (P) B. Please review the following checklist before submitting your application and sign below: Enclosed are the following documents: Completed application form Statement of Purpose One recommendation letter (submitted via ) Current official academic transcript Copy of passport (for visa processing) Application fee of $ (check or money order payable to Tulane University) I understand that it is my responsibility to ensure the delivery of any documents missing at the current time in order for my application to be considered. I also understand that t h e application fee of $ is non-refundable. I understand that I must pay the program balance upon acceptance into the program. Tulane students seeking loans to cover costs of this program should make early, specific arrangements with the Financial Aid Office, indicating that they are seeking a loan for a summer program. All students who will be receiving Financial Aid are still individually responsible for submitting the full payment to the Department of Global Health Systems and Development; the indication of an available balance in a student s Accounts Receivable balance will not be sufficient. APPLICANT SIGNATURE: PRINT NAME: DATE:, PUBLIC HEALTH IN CUBA

2 Tulane University PERSONAL INFORMATION Full Name: Tulane ID (or SSN if non-tulane): DOB: Passport Number: Expiration Date: Issuing Country of Passport: Current Mailing Address: City: State: ZIP: Primary Phone: Secondary Phone: Address: EMERGENCY CONTACT INFORMATION Emergency Contact Name: _ Relationship: Mailing Address: City: State: ZIP: Primary Phone: Secondary Phone: Address:, PUBLIC HEALTH IN CUBA

3 ACADEMIC INFORMATION Home University: Degree expected: Date expected: Major(s): Current Cumulative Grade Point Average (GPA) as of Fall 2012: Please describe any courses previously taken that are relevant to this program as well as your level of Spanish language., PUBLIC HEALTH IN CUBA

4 STATEMENT OF PURPOSE Please describe, in a paragraph or two, why you are applying to this program. Be sure to include your interests in the topics presented in the course summary and learning objectives., PUBLIC HEALTH IN CUBA

5 LETTER OF RECOMMENDATION Student Applicant: Please write your name in the space provided below before giving this form to the person who is recommending you. The completed recommendation should be sent directly to Alison Rinehart Applicant Name: Reference person: Please send y o u r l e t t e r o f r e c o m m e n d a t i o n to Alison Rinehart at the below. This recommendation will remain confidential and will be used by the program staff only in its procedures relative to admission to the Tulane University Public Health in Cuba program. Alison Rinehart Department of Global Health Systems and Development Tulane School of Public Health and Tropical Medicine 1440 Canal Street, Suite 1900 New Orleans, LA (P) arinehar@tulane.edu In your recommendation, please address the following: How long and in what capacity have you known the applicant? What are the applicant s qualifications for this particular program? Comment on the applicant s command of Spanish language, if applicable. Comment on attributes such as motivation, adaptability, intellect, and maturity. Comment on applicant s scholarship and academic preparedness. Give your full name and title/position. Sign and date the form., PUBLIC HEALTH IN CUBA