Public Health Leadership Application Form
The Boston Congress of Public Health is accepting applications for the Public Health Leadership Institute. Applications are rolling and space is limited. Last date to apply for Session 1 is March 1, 2024. FREE application. Tuition due before Institute: $500.00. Learn more at https://bcph.org/bcph_institute/. Please note that while our institutes are inclusive, they are geared for precocious high school students, college, and recent undergrads or post-bacc pre-med students. More seasoned professionals are welcome to attend these institutes as 'refresher' courses.
Primary Email
*
example@example.com
Secondary Email
*
example@example.com
Name
*
First Name
Last Name
Pronouns
*
Example: She/Her/Hers
Street Address
State
Country of Residence
*
Country of Origin
*
Background
*
Freshmen in high school
Senior in high school
Sophomore in high school
Post-bacc student (pre-med)
Junior in high school
Recent Post-grad (1 to 5 years post-college)
Other
Area(s) of public health/health interest (Select all that apply.):
*
Health policy
Health management
Maternal and Child Health
Reproductive and sexual health
LGBTQ+ Health
Men's Health
Women's Health
Substance Use, Abuse, and Addiction
Refugee/Immigrant Health
Infectious diseases
Environmental health
Occupational health
Dental Health
Global Health
Disability
Other
Why do you want to attend the Public Health Leadership Institute?
*
Competitive Advantage in Medical School
Curious about Public Health
Passionate about Public Health Issues
Refresher course, as I am a seasoned professional
Network with other Premed Students
Other
Are you interested in becoming a BCPH Research Scholar? (BCPH Research Scholars work collaboratively in order to publish work in public health and/or social justice for the HPHR Journal).
Yes
No
Professional biography (5 sentences MAX)
*
Personal Statement - Why I will benefit from attending the Leadership Institute (500-750 words, max)
*
Which Virtual Session are you interested in?
Please Select
Session 1, March 15-17, 2024, 1-4 PM PST
Session 2, March 22-24, 1-4 PM PST
Session 3, April 13-15, 1-4 PM PST
Upload your CV/resume
*
Browse Files
Cancel
of
Upload Professional Headshot
*
Browse Files
Cancel
of
Other relevant links and information:
Are you a member of the Boston Congress of Public Health? You may apply without a membership, but if awarded the fellowship, a membership must be purchased at that time. More information: https://bcph.org/membership/.
*
Yes
No, but I'd like to learn more.
Demographics
Below are some background questions that help us tailor our programming. You are not obligated to answer.
Gender: I identify as (click all that apply):
Man
Woman
Non-Binary
Trans gender
X
Other
Race: I identify as (click all that apply):
White
Black or African American
Asian
American Indian and Alaska Native
Native Hawaiian and Other Pacific Islander
Other
I am /was the first person in my family to go to college.
Please Select
Yes
No
Age
Under Age 18
19-30
31-40
41-50
51+
Please verify that you are human
*
By signing here, I understand that the application process if FREE, but the actual institutes costs $500.00 and there will be multiple payment options I can use to pay before the institute. I understand that if I am a seasoned professional, that these courses will be more refresher courses.
*
My Products
prev
next
( X )
Application Fee
$
2.00
Enter coupon
Apply
Total
$
0.00
Today's Date
*
-
Day
-
Month
Year
Date
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
Save
Continue
Continue
Clear Form
Print Form
Should be Empty: