Once submitted you will be contacted through the e-mail you listed in
Section 1 - Personal Data.
Please contact Hailey McCormick at hailey.mccormick@utah.edu or 801-585-6808 or April Sanders-Aboulila at april.aboulila@utah.edu or 801-581-6385 with questions.

What type of Certificate?


Certificate in Global Health
Certificate in Public Health
Certificate in Emergency Health
Certificate in Statistics Public Health/Biostatistics Track

Are you considered a resident by the University of Utah?


Yes
No

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 - STATISTICS CERTIFICATE APPLICANTS ONLY

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

#2 (Course Name/Number, Grade, Year Taken, Institution)

#3 (Course Name/Number, Grade, Year Taken, Institution)

#4 (Course Name/Number, Grade, Year Taken, Institution)

#5 (Course Name/Number, Grade, Year Taken, Institution)

#6 (Course Name/Number, Grade, Year Taken, Institution)

#7 (Course Name/Number, Grade, Year Taken, Institution)

#8 (Course Name/Number, Grade, Year Taken, Institution)

#9 (Course Name/Number, Grade, Year Taken, Institution)

#10 (Course Name/Number, Grade, Year Taken, Institution)

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

(Please select 9 Credit hours from the following)

Select the class you plan to take to satisfy the Statistics Electives


STAT 6003 - Survey of Statistical Computer Packages (3 Credit hours)
STAT 6769 - Introduction to Hierarchical Linear Models (3 Credit hours)
STAT 6969 - Spec Topic in Statistics (3 Credit hours)
STAT 6571 - Found. Of Applied Data Anal. & Visualization (3 Credit hours)
STAT 6572 - Nonparametric Statistics (3 Credit hours)
STAT 6573 - Practical Data Science (3 Credit hours)
STAT 6574 - Intro to Bayesian Methods (3 Credit hours)

SECTION 4 - LETTER OF INTENT

Describe why you are interested in this Certificate program:

SECTION 5 - UNOFFICIAL TRANSCRIPTS

Please email & attach your unofficial transcripts from every previous institution you have attended to Hailey McCormick at hailey.mccormick@utah.edu and April Sanders-Aboulila at april.aboulila@utah.edu