Enrollment Form, Graduate Certificate in Global HealthPlease email this form to Jeff Walker at globalgateway@unc.edu

After submitting this form to the Gillings Global Gateway, you need to meet with Jeff Walker to review your application and receive a Verification Form (to be filled out with your departmental student services manager and/or faculty advisor to inform them of your intention to complete the certificate and to register for courses).

1. Date:

2. Name: 3. PID:

4. Onyen: 5. Country of Origin:

6. Department: 7. Graduate degree program:

8. Faculty advisor:

9. Expected date of graduation (Month/Year):

10. UNC email address:

11. Phone number:

12. Permanent email address:

13. Mailing address:

14. Permanent mailing address:

To complete the course requirements of the Global Health Certificate, you must take the following: one global health foundations course (either PUBH 510 or HPM 664), two semesters of the Global Health Discussion Series (PUBH 500), and at least 6 credits of global health elective courses. You can find a list of approved classes at: http://sph.unc.edu/global-health/gh-certificates/#certificate

15. Which of the following does your degree program require (select all that apply)a. A field placement or internship experience ☐b. A doctoral thesis ☐c. A master’s paper/thesis ☐d. A group or capstone project ☐e. An equivalent paper/project ☐

i. If equivalent, please describe:f. My degree does not require any of the above ☐

16. Please describe your experiences and interests in global health below and on the following page:

Enrollment Form, Graduate Certificate in Global HealthPlease email this form to Jeff Walker at globalgateway@unc.edu

After submitting this form to the Gillings Global Gateway, you need to meet with Jeff Walker to review your application and receive a Verification Form (to be filled out with your departmental student services manager and/or faculty advisor to inform them of your intention to complete the certificate and to register for courses).