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					APPLICATION FORM Master of Public Health (MPH)

The MPH application form should be filled in and computer typed in English. It should be uploaded on our website http://mph.ehesp.fr sent with all supporting documents. We strongly recommend you to read the entire application form with the annexes before filling it in.

Academic year 2009/2010
PHOTO (if file size is too important, please join a photo in a separate file)

1. PERSONAL DATA
Name Last (Family) Name Mr Ms Mrs
(Check one)

First Name

Identity Card Number/Passport number French national student number (INE) if you were enrolled in a French university

DATE OF BIRTH (dd/mm/yyyy) PLACE OF BIRTH (city, country) CITIZENSHIP:

,

ADDRESS FOR CORRESPONDENCE Institution (if professional address) Address line 1 Address line 2 Post code City Country Telephone Fax (if available) E-mail (required)
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If you are applying as a Continuous training student (please see section 5 here under) please mention the institution or person who will pay the tuition fees :  My employer (address here above). Contact person (phone, fax and e-mail) :  Another institution : Name : Address : Contact person (phone, fax and e-mail) :  Myself
2. EDUCATION

Name of the Institution
(most recent first)

Dates of attendance City/Country Start End Field of study

Degree obtained/expected

Degree

Date (year)

3. WORK EXPERIENCE (including, if appropriate, internship)

Please complete this section and attach your resume or CV. What is your current/most recent position? (Company, department, duration, description of your tasks and responsibilities) Other previous relevant positions or internships

4. HOW DID YOU KNOW ABOUT THIS MASTER PROGRAMME?
(Tick one or several box/boxes) Colleague Employer
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College placement or careers advice office University (please specify) Publication (please specify) Electronic media (e.g. Internet) Attendance at conference, congress, meeting (please specify) Advertising (please specify where) Other (please specify )

5. CURRICULUM PATHWAYS

Please specify your academic status: Initial training*: Continuous training**:
*If you are in 2009 a regular student, you have completed your Bachelor degree, or Master degree or equivalent in 2008-2009) and you have not interrupted your studies for more than a year before applying to the MPH. ** If you have quit studies in 2008 or before, working or unemployed

Please select the chosen pathway: Admission in Year 1: Direct admission in Year 2* :
*Direct applicants to year 2 must hold a Master year 1 degree or equivalent. A professional experience of 5 years and more in the field of public health may also be considered. Please note that completion of MPH M1 does not automatically sign you in for M2. Admission in M2 is contingent upon good performance in the M1 tests.

If you request a direct admission in year 2 and do not come from a public health pathway, please explain the rationale for this choice:

***** FOR YEAR 2 APPLICANTS ONLY ***** Minor / Major choices Please rank by order of preferences (1 = first choice etc) your choices of minors and majors for year 2, to be chosen among the following tracks:  Social & Behavioral sciences in public health (SBSPH)
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   

Management & health policy sciences (MHPS) Information sciences & biostatistics (SIB) Epidemiology (EPI) Environmental & occupational health sciences (EOHS)

Full list of majors / minors is available at the end of this document (Annex 1). - Minors are “orientation modules”; 2 such modules are offered in each track. - Majors are high standard “specialisation modules”; 3 modules are offered in each track. All minor or major modules last one week. You may rank more than 2 minors and more than 3 majors, if you wish to secure your allocation to preferred modules. It is possible to select minor and/or major modules from different tracks. N.B.: Please refer to the Year 2 calendar when ranking the modules, as some may take place simultaneously. Make sure your choices are compatible with the academic schedule.

Track
Example SBSPH

MINORS* Module code/name
Behaviour Sciences and Health Education/209 Example

Track
EPI

MAJORS** Module code/name
Design, Concept and Methods in Epidemiology/221

1 2 3 4 * rank at least 2 modules

1 2 3 4 5 6 ** rank at least 3 modules

To visualise the schedule of Minors and Majors and check schedule compatibility : http://mph.ehesp.fr/year-2/ Please explain the rationale for the chosen modules:

6. LETTERS OF RECOMMENDATION

Please list the name and the contact details (to contact them quickly) at least two persons who will provide written recommendations on your behalf.

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Recommendation letters should be signed and scanned by their author and sent directly by e-mail to mph@ehesp.fr

Name 1

2

3

Contact details Phone : Fax : E-mail Phone : Fax : E-mail Phone : Fax : E-mail

7. LANGUAGE REQUIREMENTS

A very command of English is required to attend the MPH. A basic knowledge of French can also be helpful (if practicum in France, and for daily life in Paris). The minimum language requirements for English are B2 into the European Language Framework. Please tick the appropriate box, among the following:        Native language One year of studies in English at the minimum TOEIC* IELTS* TOEFL (paper-based)* TOEFL (computer-based)* TOEFL (internet-based)*

> 750 >6 > 550 > 213 > 80

* Please note that these certificates must not be older than 4 years

It is essential for all non-native English speakers to provide appropriate certificates giving evidence of the required language proficiency. Working experiences or long courses in English can be examined as a proof of your proficiency. In this case, please submit any relevant document. For more information about language testing, please visit these websites:
TOEFL and TOEIC (Test of English as a Foreign Language) : http://www.ets.org/ IELTS (International English Language Testing System) : http://www.ielts.org/

French courses are part of the regular M1 programme. Non native French speaking students of year 2 who wish to improve their capacity to communicate for daily life will be also allowed to attend these classes. Please specify whether you are willing to attend this programme (courses take place on Saturday afternoon; to be confirmed).
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I wish to attend French classes: No Please specify your level in French: Null Basic knowledge Fair/good mastering (at least 5 years of training)

Yes

8. INFORMATION ON WITHDRAWAL, TERMINATION, OR DISCIPLINARY ACTION

Have you ever withdrawn from, been dismissed from, asked to withdraw from, or been denied readmission to any academic program or institution? If so, please give all explanations. No Yes

Have you ever been subject of a disciplinary action by an academic institution, clinical training site, or within your profession? If so, please give all explanations. No Yes

10. APPLICATION FOR SCHOLARSHIPS

It is possible to apply to two different types of scholarship. For grants managed by the CNOUS1, please consult the website http://www.cnous.fr/_vie_15.htm. EHESP may also provide scholarships. Allocation of EHESP grants will be examined by the Selection committee according to academic and financial criteria. I wish to apply for an EHESP scholarship No

1

Centre National des Œuvres Universitaires (http://www.cnous.fr/_vie_15.htm)
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EHESP – Master of Public Health Academic year 2009/10 Application form

Yes

2

If so, you will be asked to fill in a separate application form. Note that ticking Yes does not ensure you will be granted a EHESP scholarship

To see the different categories of tuition cost, click here: http://mph.ehesp.fr/fees/
11. COMPLETION OF APPLICATION

  

  

  

I certify that the information presented in this application is accurate, complete, and honestly presented. I certify that all information submitted on my behalf, including letters of recommendation, is authentic. I understand and agree that any inaccurate or misleading information, as well as any omission of information, will result in the cancellation of any offer of admission, or for discipline, dismissal, or revocation of degree if discovered at a later time. I understand that my application and any materials submitted with my application becomes the property of EHESP I understand that the admission decision is final and not subject to appeal. I understand that I may be proposed to attend other minors and/or majors than the ones I selected, after evaluation of my choices and academic background by the Master executive committee; I will be asked to give approval to this alternative offer. I allow the release of my application materials to persons within EHESP for internal administrative purposes. I acknowledge that the contents of my file may not be released or forwarded to parties outside EHESP. I understand that letters of recommendation cannot be used for purposes other than review for admission.

CHECKLIST
The following list is to help you in checking that you have fully completed the application form. Please be sure to attach all required documents (please note that documents in red are compulsory for the selection. If one of these documents is missing, your application file will not be studied by the selection committee). Application Form filled and uploaded before deadline Copy of identity document Reasons for applying and career plans Curriculum Vitae A certified copy of the diplomas (minimum Bachelor for Master year 1 applicants) and the official translation in English or French Official written transcripts and mark sheets in English or French (or official translation in English from the candidate’s native language if not English or
2

Note that applying for an EHESP scholarship has no impact on the review process of your application to the MPH programme
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French) from all colleges and universities or any other institution of higher education attended Evidence of language proficiency Willingness to attend French language classes At least two letters of recommendation sent by e-mail by the recommender to mph@ehesp.fr Photo

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Annex 1 Year 2 : List of minors and majors
Social & Behavioral sciences in public health (SBSPH) A. Evaluation of public health programmes (208) B. Behaviour sciences and health education (209) A. Chronic disease, aging and long term care (218) B. Epidemics, vaccination, addiction and mental health (219) C. Innovation in health (220) Management & health policy sciences (MHPS) A. Management tools in health services (212) B. Foundation of health policy (213) A. Decision-making in health (224) B. International comparisons of health systems and policies (225) C. Decision in action (226) Information sciences & biostatistics (SIB) Mathematical and computational modelling (214) Hierarchical models (215) Advanced modelling in biostatistics (227) Integrative modelling (228) Synthesis (229) Epidemiology (EPI) Infectious disease epidemiology (210) Epidemiology of chronic disease (211) Concepts, methods and design in Epidemiology (221) Analysis and measurement in Epidemiology (222) Variable topic (e.g.: cardiovascular disease, cancer, psychiatry, etc.) (223)

Minors

Majors

Minors

Majors

Minors

Majors

A. B. A. B. C.

Minors

Majors

A. B. A. B. C.

Minors

Majors

Environmental & occupational health sciences (EOHS) A. Health risk assessment (216) B. Global environmental changes (217) A. Global environmental changes (230) B. Advanced issues in risk assessment (231) C. Critical windows of exposures and vulnerability (232)

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Annex 2 Tuition fees
Tuition fees for the Master of Public Health in 2009 will be the following:    for students from EU countries and students : official rate fixed by the French Ministry of Higher Education (226 € per year for 2008/2009) to which is added the Social Security fee, sew below. 6 000 € per year for non-EU students (international cooperation programme) 6 000 € per year for attendees in a Continuous Education framework (with delivery of the Master degree after year 2)

Tuition fees include:       Enrollment in all the teaching units and modules Provision of all teaching aids and documents Free access to library facilities Language course (for M1 and M2 students in the international cooperation programme) Organization of study trip abroad (year 1) and of the practicum (year 2) Individual tutoring for M1 and M2 students in the international cooperation programme

They do not include costs related to accommodation, food, international travel (including travel for M1 study trip -unless non EU students and continuous education enrolees- and M2 practicum), and travel in Paris or in France, nor health and other insurance. Once a candidate is officially selected, a first instalment will be required to guarantee his / her place in the Masters. Scholarships Three types of scholarship may be delivered by EHESP. All are based on social criteria, according to a scale established by the French CROUS, and on academic curriculum excellence:    Housing aid (HA) : eligible students may receive up to 400 EUR monthly grant, as a means to alleviate housing costs in Paris (subject to renting contract to be presented). Social aid (SA) : following the CROUS scale, eligible students may receive up to 400 EUR monthly grants. Fees waiver (FW) : eligible students subject to the international fees level may have the fees reduced by 50% or even lowered up to the baseline EU yearly level.

To ask for a scholarship please fill the form on the MPH website : http://mph.ehesp.fr/MPH_Fees_Scholarships.html and provide the required pieces of information along with your application. Request of a scholarship has no impact on the evaluation of your MPH application, which will be based exclusively on academic excellence criteria. Final decisions will be taken by the EHESP social aid committee on a case by case basis.

Social security Fees
They depend on your age and income level. Please note that all students under 28 years will have to take student social security (195€/year for 2008/2009 academic year).

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Annex 3 Selection criteria
The following table shows the weighting allocated to each criterion and sub-criterion.
CRITERION SUB-CRITERION Marks, classification, grades and distinctions obtained Autonomy and initiative; willingness and suitability for working in a team (based on the letters of recommendation) WEIGHTING 8 Total = 16 8

Education

Professional experience or equivalent (volunteer work in NGOS, professional placement, internships, etc.) Reason for choosing the EHESP Master Cultural adaptability As part of a career plan Relevance of the majors ranked with respect to previous training and career prospects Language skills International projects or prospects

4 5 5 5 5

Total = 4

Total = 10

Total = 10

GRAND TOTAL = 40

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