THIS IS A SAMPLE APPLICATION PACKET
THE 2019 CENTER FOR DIVERSITY IN PUBLIC HEALTH LEADERSHIP TRAININGPROGRAMS ONLINE GUIDELINESMaternal and Child Health Careers/Research Initiatives for Student Enhancement –Undergraduate Program (MCHC/RISE-UP)Thank you for your interest in the Maternal and Child Health Careers/Research Initiativesfor Student Enhancement – Undergraduate Program (MCHC/RISE-UP).THIS IS A SAMPLE APPLICATION PACKETIMPORTANT: Please review the instructions before beginning the onlineapplication. You MUST complete the entire application in one session (2 hours maximumtime allowed). This form will NOT save and allow you to return to complete. Once theentire application is completed you can print it. Please be prepared to print yourapplication or change your print options and print to a PDF for your records.Navigate the form (move from field to field) by hitting the tab button.At the end of these instructions is the link to the MCHC/RISE-UP Online Application. Pleasenote that all applications must be completed using the Center Program’s Online Application.Applications submitted AFTER the deadline of January 31, 2019, 11:59PM (Eastern StandardTime) will automatically be deleted from the system. All applications are automatically datedand time stamped. If applying online poses a hardship, please contact our office during businesshours (9:00 AM to 5:00 PM Eastern Standard Time) before the closing date for an alternatesubmission method (443-923-5901).IMPORTANT: Be prepared to complete the application in one session (2 hours), as youwill NOT be able to save the form and return to complete later; you will be given the optionto PRINT the form once you hit SUBMIT. Have all of your documents and informationreadily available and saved in the final formats. Many of the fields are required (REVIEWAPPLICATION CHECKLIST BEFORE BEGINNING THE APPLICATION).The below instructions will help you prepare and complete the application. Before opening theapplication, please review the instructions and this SAMPLE application in detail.The Program staff will not make any changes to submitted applications. Please review yourapplication carefully prior to submitting, especially the email addresses you enter for yourreferees.You will need to have the following information and electronic documents saved and accessibleon the computer you will be using to upload into the application or copy and paste into theapplication.Uploaded files should be in the following format and cannot exceed 25 MB (PDF format): Resume (PDF format): save file as: last name first name resume
Unofficial Undergraduate Transcript (PDF format): save file as: last name firstname ugtranscriptUnofficial transcript includes your name and the school name.Have the following items completed and saved in a word document so you can cut and paste intothe online application—each response is not to exceed 250 words:1. The three (3) Short Answer Responses2. Essay Question 1 (required) and select one from Essay 2a, 2b, or 2c3. Name, email, and phone number of two faculty references (referees)IMPORTANT NOTES: Please check and confirm you have entered the correct email foryour referees. A reference request will automatically be sent to the email address enteredon your application. Your referees may need to check their spam and/or junk mail folder.APPLICATION ACKNOWLEDGEMENT AND SUBMISSION:Please type your full name in the field provided. Click Sign under the Signature Box. Use your cursor (or if you have a touch screen) sign your name in the box. Click Done, located below the signature box, when completed.1) When you complete the application return to the top right column of the applicationand click SUBMIT. If you forget to complete a section, hitting the SUBMIT button willnotify you what required items are missing in the Record Save Checklist (right column).2) Saving the Record may take a few seconds. Once completed you will be given the optionto Closeor Print.Please be prepared to print your application or change yourprint options and print to a PDF for your records.3) Again, you will NOT be able to save the form AND return to complete later. THESAVE RECORD BUTTON SUBMITS COMPLETED APPLICATIONS TO THEMCHC/RISE-UP PROGRAM OFFICE.4) For your tracking, you will receive the following automatic emails (we recommendyou save these emails):A) A confirmation receipt upon submission of your applicationB) Notification when a referee submits a recommendation form to theMCHC/RISE-UP Program office.IMPORTANT: Please review the sample application before beginning the onlineapplication.This is NOT the Online Application—this is a SAMPLE DOCUMENT
10/25/2018Center for Diversity in Public Health Leadership Training ApplicationCenter for Diversity in Public Health Leadership Training ApplicationApplicant InstructionsThis application must be completed in a two-hour session. We suggest you thoroughly review theSAMPLE APPLICATION (click HERE) and CHECKLIST (click HERE) before beginning to ensureyou have all information needed and documents you plan to upload readily accessible before starting.You will not be able to begin, save and return to complete this application. The SUBMIT button on theright top column will save and SUBMIT your application.Please review your application carefully. The program willNOTmake any changes to your application.Select Center ProgramNameDOBFor which center program are you10/25/2018 applying?MCHC/RISE-UPMCHC RISE-UP TESTAre you a U.S. Citizen, Permanent Resident, or U.S.National with necessary documentation?YesPlease confirm the informationentered is correct.YesSAMPLEMCHC/RISE-UP Applicant Eligibility Screen1) Is your GPA 2.7 or greater WITHOUT rounding and verified on your unofficial transcript currently?Yes2) Are you currently an undergraduate rising junior, junior, senior or a post-bac that has/will graduate between May 2018 and May 2019?YesApplicant InformationDate10/25/2018Email AddressEmail Address (personal email)TEST@GMAIL.COMTEST@GMAIL.COMPhone: LocalPhone: Home000-000-0000000-000-0000Phone: CellGender000-000-0000OtherPlease specify other gender:TESTRace (Please select the best description of your race)Ethnicity (Hispanic or Latino)?Other Race (please specify)OtherPlease specify race details:Please specify other ethnicity:TESTTESTPrimary language spoken at homeCitizenship statusOtherU.S. CitizenOther primary language spoken at home:TESTFirst generational college?YesAre you first (1st) or second (2nd) generation U.S. Citizen or PermanentResident?First generation Permanent nt/print/id/3964201/7
10/25/2018Center for Diversity in Public Health Leadership Training ApplicationWhat is the country(ies) of your family’s origin?TESTHave you ever received free or reduced price lunch benefits?Pell grant eligible?YesYesI learned about the Center Program from:Do you know your FAFSA EFC (Expected Family Contribution) score?Social Networking site (i.e., Facebook, Twitter)YesFAFSA EFC (Expected Family Contribution) score:23.00If accepted, will you require any special accommodations?YesAccommodationsPersonal assistantOtherIf you require other/additional special accommodations, pleasedescribe the type you will need, below.TESTName of personal assistant, if applicableTESTAddress SelectionIs your local address within the United States?Is your permanent address within the United States?YesNoLocal U.S AddressSAMPLEAFTER TYPING IN YOUR LOCAL ADDRESS, BE SURE TO CLICK "SELECT TO MAP" AS SEEN BELOW, TOENSURE YOUR ADDRESS IS SAVED.AddressCityState707 North BroadwayBaltimoreMarylandCounty Zip21205Non-U.S AddressPermanent AddressAddress- (permanent)TESTCity- (permanent)TESTState (permanent)TESTCounty- (permanent)TESTZip Code- (permanent)TESTCountry (permanent)TESTCollege/University and olutions.com/document/print/id/3964202/7
10/25/2018Center for Diversity in Public Health Leadership Training ApplicationMinority Serving InstitutionOther Minority-servingWhat is your career focus?Clinical FocusWhat is your future career setting? (Select your top 1 or 2 settings)Academic SettingCommunity SettingPrivate/For-Profit SettingPrivate Practice SettingPublic Health Experience-- Please identify your public health experience by selecting one (1) of the categories.Engagement: I am considering pursuit of public health in the context of another health related discipline, e.g., MD, DO, RN, DDS, Social Work, etc.Anticipated Graduation Date10/25/2018Student Classification (MCHC/RISE-UP)Post-baccalaureate (see definition for Post-Baccalaureate)GPA Range: (MCHC/RISE-UP)3.5 to 4.0Actual GPA: MCHC/RISE-UP3.70Post-Baccalaureate Graduation Date10/25/2018My Highest Educational Goal (MCHC/RISE-UP & MCH-LEARN)Other Master's DegreesCurrent Major (MCHC/RISE-UP & MCH-LEARN)Pre-MedSite PreferenceSAMPLESite Preferences (MCHC/RISE-UP)University of California, Davis, CAHousingI need housing for the orientation inBaltimore, MD: (MCHC/RISE-UP)I need housing for the summertraining site: (MCHC/RISE-UP)I will need parking information for the summer training site (NOTE:Parking fees are not covered by the Program): (MCHC/RISE-UP)YesYesYesMCH-LEARN & MCHC/RISE-UP Leadership TracksMCHC/RISE-UP: You can select 1 or 2 of the 3 Leadership TracksClinicalCommunityResearchClinical Leadership Track ONLY: Please rank your top 3 choices using the selection choices below:Spine (occupational and physical therapy) Interdisciplinary transition program Speech Physical therapyOccupational therapy Neuro-psychology Behavior psychology Nutrition Social work Medicine1st ChoiceOccupational therapy2nd ChoiceNutrition3rd ChoiceSpeechShort t/print/id/3964203/7
10/25/2018Center for Diversity in Public Health Leadership Training Application1. Describe your past community service, leadership, and/or research experiences. (250 word maximum)TEST2. How do you anticipate participating in this program/fellowship will help your future career goals? (250 word maximum)TEST3. List any achievements (i.e., honors or awards) (250 word maximum)TESTMCHC/RISE-UP EssaysESSAY QUESTION 1 : Why is taking a public health approach important to achieve health equity? (250 word maximum)TESTPlease complete 1 of the 3 essays questions below.ESSAY QUESTION 2a: (Clinical) How would you use a public health approach to address a Maternal and Child Health challenge and/or an areaof developmental disability? (250 words or less)TESTESSAY QUESTION 2b: (Community Engagement and Advocacy) Discuss how leadership impacts public health practice and policy. (250words or less)TESTESSAY QUESTION 2c: (Research) What do you believe is (are) the most important public health challenge(s)? Why did you choose this(these) challenge (s) and how would you solve it (them)? (250 words or less)TESTCurriculum Vitae or Resume and Undergraduate TranscriptSAMPLEPLEASE CHECK THE ACCURACY OF FILES UPLOADED.Curriculum Vitae or Resume (PDF Format)/document/download/filename/1540482052 41291 graphs.docx/Below, attach your Unofficial University Undergraduate Transcript (PDF format).Please ensure the transcript includes your name and the school name.PLEASE NOTE: AN OFFICIAL UNDERGRADUATE TRANSCRIPT IS REQUIRED UPON ACCEPTANCE.University Undergraduate Transcript/document/download/filename/1540482052 41292 graphs.docx/Referee InformationTwo forms of recommendation from faculty at your previous or current university are required.Upon submission (SAVE RECORD) of your application. An email will automatically be sent toeach referee with instructions on how to submit a recommendation on your behalf.All recommendations must be completed using the electronic form provided to each referee.Deadline for receipt of recommendations is January 31, 2019 11:59 PM EASTERN TIME.Referee 1TEST TESTReferee 1SuffixPh.D.Referee 1: Institution/OrganizationTESTPLEASE CHECK ACCURACY OF REFEREE EMAIL nt/print/id/3964204/7
10/25/2018Center for Diversity in Public Health Leadership Training ApplicationReferee 1: EmailTEST@gmail.comReferee1 Phone #000-000-0000Email Trigger- Ref 1Email SentFrom: apricotsoftwarealerts@gmail.comTo: TEST@gmail.comSubject: MCHC/RISE-UP Letter of Recommendation RequestBody: Dear TEST TEST, Ph.D.MCHC TEST, Applicant 2019 - Applicant ID: 396420 has requested a letter of recommendation from you for the MCHC/RISE-UPProgram. The submission date for letters of recommendations is on or before January 31, 2019.Please complete the recommendation form through the link ogin/org 357The link will only open in one of the following browsers: Google Chrome, Mozilla FireFox, or Safari (you may have to cut andpaste the link into your browser).Please address the following characteristics in your letter of recommendation. The form provides a space to allow you to cut and paste(Ctl V) your letter of a maximum of 850 WORDS. Letters of recommendation must be completed in one on-line session. Youwill NOT have the ability to save and return! Consider the following items in when constructing your comments: How long and in what capacity you have known the applicant Qualities the applicant possesses (i.e., intellectual ability, cooperation, integrity, initiative in learning, communication--written and oral)SAMPLE Applicant’s strengths and areas for improvement Overall strength of your endorsement (i.e., highest recommendation, highly recommended, recommend with confidence,recommended with reservation, etc.)Please enter the Applicant ID 396420 and the applicant's email address TEST@GMAIL.COM on the online form.To submit the form, please click ‘Save Record’ (top right column on the page). You will not be able to save and return.If you experience any problems completing the referee form simply copy and paste the form in an email, reference the Applicant Nameand ID in the subject line, and email to the appropriate program email address below:PROGRAMEMAIL ADDRESSThankDiseasesyou,The ProgramFacultyJames A. Ferguson Emerging InfectiousFellowship(Ferguson Fellowship)**This is an automatic message, please do not reply.Ferguson dit/id/396420Referee 2TEST TESTReferee 2SuffixBSReferee 2: Institution/OrganizationTESTPLEASE CHECK ACCURACY OF REFEREE EMAIL ADDRESSReferee 2: EmailTEST@gmail.comReferee 2 Phone #000-000-0000Email Trigger-Ref t/id/3964205/7
10/25/2018Center for Diversity in Public Health Leadership Training ApplicationEmail SentFrom: apricotsoftwarealerts@gmail.comTo: TEST@gmail.comSubject: MCHC/RISE-UP Letter of RecommendationBody: DearTEST TEST BSMCHC RISE-UP TEST, Applicant ID 2019:396420 has requested a letter of recommendation from you for the MCHC/RISE-UPProgram. The submission date for letters of recommendations is on or before January 31, 2019.Please complete the recommendation form through the link ogin/org 357The link will only open in one of the following browsers: Google Chrome, Mozilla FireFox, or Safari (you may have to cut andpaste the link into your browser).Please address the following characteristics in your letter of recommendation. The form provides a space to allow you to cut and paste(Ctl V) your letter of a maximum of 850 WORDS. Letters of recommendation must be completed in one on-line session.You willNOT have the ability to save and return! Consider the following items in when constructing your comments: How long and in what capacity you have known the applicant Qualities the applicant possesses (i.e., intellectual ability, cooperation, integrity, initiative in learning, communication--written and oral) Applicant’s strengths and areas for improvement Overall strength of your endorsement (i.e., highest recommendation, highly recommended, recommend with confidence,recommended with reservation, etc.)SAMPLEEnter the Applicant ID: 396420 and the applicant's email addressTEST@GMAIL.COM on the online form.To submit the form, please click ‘Save Record’ (top right column on the page). You will not be able to save and return.If you experience any problems completing the referee form simply copy and paste the form in an email, reference the Applicant Nameand ID in the subject line, and email to the appropriate program email address below:PROGRAMEMAIL ADDRESSThankDiseasesyou,The ProgramFacultyJames A. Ferguson Emerging InfectiousFellowship(Ferguson Fellowship)Ferguson LOR@**This is an automatic message, please do not reply. id/396420Emergency ContactEmergency Contact NameTESTPhone: Emergency Contact000-000-0000AddressPostal Code707 North Broadway Baltimore Maryland21205Consent and Application AcknowledgementI agree to be contacted to help evaluate the need for summer public health leadership programs. Participation in an end of summer evaluationwill include a drawing for a gift card.YesBy signing below you understand that you are waiving your right to request that the Center for Diversity in Public Health LeadershipTraining send you recommendations that your referees have submitted on your t/print/id/3964206/7
10/25/2018Center for Diversity in Public Health Leadership Training Application*Please type your full name and provide signature in the box using the cursor. By doing so you acknowledge that the information contained inthis application is true and accurate to the best of your knowledge and that information may be summarized and shared with the FederalFunding Agency.SignatureNameWitnessed ByTESTMegan Reed on 10/25/2018 11:40Carefully review your application for accuracy prior to submitting your application. The Program Office will notmake revisions to your application once it is submitted.To SUBMIT your application, click 'SUBMIT' (top right column).If you DO NOT receive an Email confirmation following the submission of your application, please 964207/7
COMPLETING ONLINE APPLICATION CHECKLIST: Carefully reviewed the sample application Created Word document so you can cut and paste into the online application—eachresponse does not exceed 250 words:a. The three (3) Short Answer Responsesb. Two (2) required Essay Questions Confirmed the contact details of your two faculty references (referees) are accuratea. Name, email, and phone number of two faculty references (referees)b. A reference request will automatically be sent to the email address entered onyour application. Your referees may need to check their spam and/or junk mailfolder. Created resume/CV PDFa. File does not exceed 25MBb. Saved file as: last name first name resume Created undergraduate transcript PDFa. File does not exceed 25MBb. Unofficial transcript includes your name and the school name.c. Saved file as: last name first name transcriptAPPLICATION LINK:If you are ready to complete the MCHC/RISE-UP Application PLEASE CLICK HERETO BEGIN. (Right click on the TEXT LINK and select Copy Hyperlink, then paste URLinto one of the following Browsers: FireFox or Google CHROME).You MUST complete the entire application in one session (2 hours maximum time allowed).This form will NOT save and allow you to return to complete. Please review theaccuracy of completed application prior to submission. The Program staffwill not make any changes to submitted applications.Once the entire application is completed you can print it. Please be prepared to print yourapplication or change your print options and print to a PDF for your records.Applications submitted AFTER the deadline of January 31, 2019, 11:59PM (Eastern StandardTime) will automatically be deleted from the system. All applications are automatically datedand time stamped. If applying online poses a hardship, please contact our office during businesshours (9:00 AM to 5:00 PM Eastern Standard Time) before the closing date for an alternatesubmission method (443-923-5901).
Curriculum Vitae or Resume and Undergraduate Transcript Referee Information TEST 1. Describe your past community service, leadership, and/or research experiences. (250 word maximum) TEST 2. How do you anticipate participating in this program/fellowship will
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