SUBSIDIZED - Public Health Summer Institute and Medical Academy

Public Health Leadership Summer Institute and Medical Academy

Application + Registration Fee + Tuition (LIMITED TIME ONLY)
Information

The Boston Congress of Public Health seeks to educate an inclusive learning audience with a strong interest and passion for public health and social justice. The following tuition is now possible for a limited time: Public Health Leadership Summer Institute ($375.00) and Medical Academy ($250.00). Be mindful of the session locations, dates, and times that you select. Participants are NOT required to stay overnight in the designated hotels for the program, and can commute in from anywhere. ALSO - A DOWNLOAD option is AVAILABLE by August 2023 and can be bought ahead of time if one cannot make it in-person. Please see for detailed description: https://bcph.org/summer-institute-medical-academy-session-programs/.
Participant Name*

First NameLast Name
Preferred Email*
Alternative Email*
School/University/Employer*
I am a ...*
I will be attending the following Public Health Leadership Summer Institute:*

Session 3: August 3-6, 2023: Near George Washington University, Royal Sonesta, Washington, D.C.Not applicable
I will be attending the following Medical Academy:*

Session 3: August 2, 2023: Near George Washington University, Royal Sonesta, Washington, D.C.Not applicable
I will be traveling and will be looking for hotel accommodations within the area. Note: BCPH has rooms discounted on a limited and first come, first serve basis.

YesNo
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Name/Email/Phone - Must complete if in high school
How would you rate your knowledge of public health?*

1

2

3

4

5

1 is Worst, 5 is Best
How would you rate your knowledge of social justice?*

1

2

3

4

5

1 is Worst, 5 is Best
Why do you want to attend the Public Health Leadership Summer Institute and/or Medical Academy? (250 words max)
Why do you want to attend the Public Health Leadership Summer Institute and/or Medical Academy? Check all that apply.*

I am excited to participate in a transformational educational experience -- and explore the intersection of public health, clinical medicine, and social justice topics.I want to explore diverse career paths, as I am undecided about my future college major, but know that this institute and academy can be beneficial regardless of what path I choose.I want to engage in unique and immersive learning experiences (documentary film exploration, health simulations, case studies), and tours of prestigious universities like Harvard, MIT, Georgetown, and UCLA.I am enthusiastic to learn about a range of topics, such as social and political determinants of health, health policy and management, maternal and child health, refugee and immigrant health, LGBTQ+ health, public health entrepreneurship, racial justice, gender equity, and more.I want to be part of a pressure-free intellectual engagement, and learn from leading public health and social justice scholars.I am committed to social justice and becoming an effective ally, advocate, or activist for diverse, underrepresented, marginalized, and vulnerable communities.I want to earn Certificates of Achievement in Public Health and Academic Journalism.I am preparing for a Master's in Public Health, Doctorate in Public Health, Medical School, or other health-related professional field.I am looking for a refresher training or professional development on public health and/or social justice topics.
OPTIONAL ESSAY - What is the most pressing Public Health and/or Social Justice issue today? (500 words max) - winning essays will be published in HPHR Journal at hphr.org.
Are you a member of the APHA?*

YesNo
Professional Headshot (all) - we will need to ensure appropriate identification of participants*

Cancelof
Signed Media Release Form: This will allow BCPH to take photos of you during the event. Click to download. (Full URL for download: https://bcph.org/wp-content/uploads/2023/04/BCPH-Media-Release-Form_2022_23.pdf.)
I have fully read the Boston Congress of Public Health Media Release Form and fully agree to its content.

YesNo
Student Code of Conduct: Required for high school students. Click to download. (Full URL for download: https://bcph.org/wp-content/uploads/2023/04/Student-Code-of-Conduct-Public-Health-Summer-Institute_Pre-Medical-Academy.pdf)
I have fully read the Student/Participant Code of Conduct and fully agree to its content.

YesNo
Student Waiver: Required for high school students: Click to download. (Full URL for download: https://bcph.org/wp-content/uploads/2023/04/BCPH-Public-Health-Summer-Institute-Waiver-Form-.pdf)
I have fully read the student waiver for high school students and fully agree to its content.

YesNo
Confirmation

ALL INFORMATION SUBMITTED HEREIN IS TRUTHFUL AND NOT INTENTIONALLY MISLEADING TO THE BEST OF MY KNOWLEDGE.

I ACKNOWLEDGE THAT I HAVE READ THE PRIVACY, REGISTRATION, AND CANCELLATION DOCUMENTATION AND AGREE TO LAWFULLY ABIDE BY THESE TERMS GIVEN ANY FUTURE ISSUE.

I ACKNOWLEDGE THAT THE BOSTON CONGRESS OF PUBLIC HEALTH (BCPH) IS A SOCIAL JUSTICE ORGANIZATION THAT VALUES AND ESPOUSES THE PRINCIPLES OF DIVERSITY, INCLUSION, EQUITY, AND ANTI-RACISM. I UNDERSTAND THAT BCPH DOES NOT DISCRIMINATE ON THE BASIS OF RACE, ETHNICITY, GENDER, NATIONALITY, SEXUAL ORIENTATION, RELIGION, IDEOLOGY, POLITICAL PREFERENCE, OR OTHERWISE.

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date*

MonthDayYear
Date
Please make your selections judiciously. When completing the form, be sure to:

- Select registration fee.

- Select your Public Health Institute and/or Pre-Medical Academy sessions. (These require separate purchases.) Sessions are as follows:
- Session 1: July 12-16, 2023: Near Harvard University, Cambria Hotel Boston, Boston/Cambridge, MA
- Session 2: July 19-23, 2023: Near Harvard University, Cambria Hotel Boston, Boston/Cambridge, MA
- Session 3: August 2-6, 2023: Near Georgetown & GW Universities, Royal Sonesta Hotel, DC
- Session 4: August 9-13, 2023: Near UCLA, E-Central Los Angeles Hotel, Los Angeles, CA
- Note:
- Tuition does NOT include travel expenses, meals, or lodging.
- Please email communications@bcph.org with additional questions if uncertain about a purchase decision.
- Cancellation policies are available on www.BCPH.org.

BCPH Summer Institute and Medical Academy Order Form

Registration Fee (NON-REFUNDABLE)Includes reading and processing fee for applications.

$15.00 Quantity

Public Health Institute - Session 3 (Washington, D.C.)Cancellation policies will strictly apply.

$375.00 Quantity

Medical Academy - Session 3 (Washington, D.C.Cancellation policies will strictly apply.

$250.00 Quantity

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Public Health Leadership Summer Institute and Medical Academy

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