Certificate Program Application

Once submitted you will be contacted through the e-mail you listed in 

Section 1 - Personal Data.

Please contact Josué Martinez at Josué.Martinez@utah.edu or 801-587-7896 with questions.

What type of Certificate?

Check one:

Are you considered a resident by the University of Utah?

(If not sure, please call the Residency office at 801-581-8761):

Term and Year applying

(Choose only one)

SECTION 1 - PERSONAL DATA

SECTION 2 - ACADEMIC BACKGROUND

SECTION 3 - GLOBAL HEALTH CERTIFICATE APPLICANTS ONLY

List the semesters and year you plan on taking each core course:

List the semesters and years you plan on taking each approved elective:

SECTION 3 - PUBLIC HEALTH CERTIFICATE APPLICANTS ONLY

List the semesters and year you plan on taking each core course:

SECTION 3 - EMERGENCY HEALTH CERTIFICATE APPLICANTS ONLY

List the semesters and year you plan on taking each core course:

List the semesters and years you plan on taking each approved elective:

SECTION 3 - PUBLIC HEALTH STATISTICS CERTIFICATE APPLICANTS ONLY

Please list the Pre-Requisites you have completed in order to take the below Public Health/Biostatistics Courses

List the semester and year you plan to take the Public Health / Biostatistics Courses

(Please select 9 Credit hours from the following)

This should be noted, “Classes may not be offered every year. Applicants will need to verify with Laura Egbert (laura.egbert@utah.edu), prior to making their selections”.

Please select 6 Credit hours from the following:

SECTION 4 - LETTER OF INTENT

SECTION 5 - UNOFFICIAL TRANSCRIPTS

Please email & attach your unofficial transcripts from every previous institution you have attended to Josué Martinez at josue.martinez@utah.edu