MPH Registration Request

MPH Registration Request

This form is only applicable to MPH students who need to register for courses.
*Please consult your MPH Academic Advisor prior to completing this form.
Date form was submitted*

MonthDayYear
Date
Name*

Last NameFirst Name
UIW Identification Number*
Phone Number*
Please enter a valid phone number.
UIW Email Address*

Confirmation Email
Select the applicable semester*

Fall IFall IISpring ISpring IISummer

Term: Summer

PUHL 6301 - Biostatistics (8 wks)

PUHL 6302 - Epidemiology (8 wks)

PUHL 6305 - Social & Behavioral Aspects PH (8 wks)

Term: Fall I

PUHL 6301 - Biostatistics (8 wks)

PUHL 6309 - Rural Health and Aging (8 wks)

PUHL 6311 - Climate Change (8 wks)

PUHL 6313 - Applied Practice (16 wks)

PUHL 6315 - Maternal & Child Health (8 wks)

Term: Fall II

PUHL 6303 - Environmental Health (8 wks)

PUHL 6306 - Community-Oriented Primary Care (8 wks)

PUHL 6305 - Social and Behavioral Aspects of Health (8 wks)

Specify Term and Course(s) to be added: *
What funds will you be using to pay for the tuition/fees for the course?*

If, I have the option, I would like to use federal loans to pay for the course(s)I will be using private loans to pay for the course(s)I will be paying for the course(s) using personal funds
Do you authorize UIWSOM to route a Cost of Attendance Adjustment to the UIW Office of Financial Assistance to reflect additional tuition that will need to be incorporated in your financial aid award package? **This will not automatically increase your loans to cover the additional tuition cost**

YesNo
Would you like to request your federal loans be increased to account for the additional MPH tuition, and additional living expenses? If you select yes, please expect an email from Ms. De La Rosa with additional documentation to be signed.

YesNo
By submitting this form, I confirm I have consulted my MPH Academic Advisor and authorize UIWSOM to register me in the course(s) requested above.*

I agree
Should be Empty: