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    Field Placement Waiver Application

    If applicable, please submit this form during your first semester of enrollment in the MPH Program.  Also, please email the Program Coordinator a current resume/CV and a completed Competency Self Assessment, which can be accessed on the Field Placement Forms website.

    *Note:  All fields of this form are required.

     

    Student Statement
    I request a waiver of the supervised MPH Field Placement.  I have more than five years of relevant, full-time public health experience.  I have acquired the skills and experience in the application of core public health concepts and specialty knowledge to the solution of community health problems through prior field-based experience/employment.
        Student Name
        Email
        Phone
       
    Description of Experience
    Please describe how your prior experience demonstrates your proficiency in the core and specialty public health competencies of your academic program.  (Please refer to your Competency Self Assessment for this description.)
       
    Signature
    By typing my name below, I certify that the information provided in this form is complete and accurate, and I request that you consider my application for a waiver from the Field Placement requirement of the MPH Program.
        Signature
        Date