Field Placement Waiver Application

If applicable, please submit this form during your first semester of enrollment in the MPH Program.  Also, please email Laura Conklin, 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

 

Medical College of Wisconsin
8701 Watertown Plank Road
Milwaukee, WI 53226
(414) 955-8296
Directions & Maps
© 2014

Page Updated 10/23/2014
Top