SOUTHERN CONNECTICUT STATE UNIVERSITY by mikeholy

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									SOUTHERN CONNECTICUT STATE UNIVERSITY
    DEPARTMENT OF PUBLIC HEALTH

  GRADUATE PUBLIC HEALTH PROGRAM




APPLICATION DOCUMENTS
                      Southern Connecticut State University
                      School of Health and Human Services
                          Department of Public Health

                                     Personal Essay
 Directions: Please discuss within a limit of 250 typed words, your specific reasons
             for seeking the M.P.H. and your potential contributions to the field of
             public health. It is essential that you convey your interest and passion for
             public health in your essay Essays are evaluated on content, command of
             English grammar, style and organization. You may attach your
             statement to this form.




 Name: ___________________________ Signature: __________________________
 Date: ____________


Return to:     M.P.H. Admissions Committee
               S.C.S.U., Department of Public Health
                       144 Farnham Avenue
                       New Haven, Connecticut 06515


Student ID ____ ____ ____ ____ ____ ____ ____ ____
                                                            Essay.doc., revised 2009
                                 Letter of Recommendation
                       For Admission to the Graduate M.P.H. Program
                          at Southern Connecticut State University

[This section to be completed by the applicant]                            Date _________
RETURN TO:              M.P.H. Admissions Committee
                        Department of Public Health
                        Southern Connecticut State University
                        144 Farnham Avenue
                        New Haven, CT 06515

APPLICANTS NAME:_________________________________________________________
                      Last, Family or Surname         First        Middle

ADDRESS:___________________________________________________________________
           Street Address            City/State          Zip Code

Social Security No. __ __ __ - __ __ - __ __ __ __

Under the provisions of the Family Rights and Privacy Act of 1974, you may decide whether
letters of recommendation written at your request are to be held confidential or whether they are
to be available for your personal inspection. Check one of the following statements and place
your signature in the space provided so that the referee will be advised of your choice.

______    Confidential file. I grant permission for this letter of recommendation to be held
          confidential by Southern Connecticut State University.

______    Open file. I retain the choice of having letters of recommendation available to me.

                                                ______________________________________
                                                               Signature of Applicant
_____________________________________________________________________________
[This section to be completed by the individual making the recommendation]
You may wish to make additional comments by letter. If so, please attach your letter to this form
so that the Department may identify the applicant’s choice with respect to the right of access
under the Family Educational Rights and Privacy Act.

Please note that while the applicant may have waived his/her right of access under the Family
Educational Rights and Privacy Act, in some circumstances this letter may be subject to
disclosure under the provisions of the Connecticut Open Records Act. Please mail this
recommendation directly to Southern Connecticut State University at the address noted above.
1. Knowledge of the Applicant
      Approximately how long have you known this applicant? ____months ____years
      How well do you feel you know the applicant? ____ well ____very well
      What was the nature of your contact(s) with applicant? _______________________
      Teacher _____ Research Advisor _____ Major Advisor _____ Employer _____

         Other (specify):_______________________________________________________
                                                            Please complete reverse side
2. Evaluation: In comparison with other students in the same field who have the same
   amount of experience and training, I rate this person as follows:

           Evaluation Criteria               Top       Top       Top       Upper       Unable
                                             5%        10%       20%        50%        to Rate
Knowledge base in public health
Ability to grasp new concepts
Originality, intellectual creativity
Mathematical and logical thought
Written expression
Oral expression
Ability to work with others
Perseverance toward goals
Ability to meet deadlines

3. Recommendation: Considering this applicant’s academic record, special abilities, ambition
           and determination, please indicate your recommendation:

    ______ Recommend Strongly                         ______ Recommend with Reservation

    ______ Recommend                                  ______ Cannot Recommend

4. Please add any comments which you believe will assist the Admissions Committee in
   assessing the applicant’s potential to successfully pursue graduate study in public
   health.




Name of Referee (please print): ___________________________________________________

Signature: ____________________________________________________________________

Title: ________________________________________________________________________

City, State, Zip Code: ___________________________________________________________

Phone Number: (        )______________________________________ Date ________________


                                                                                       reclet.frm
                                 Letter of Recommendation
                       For Admission to the Graduate M.P.H. Program
                          at Southern Connecticut State University

[This section to be completed by the applicant]                            Date _________
RETURN TO:              M.P.H. Admissions Committee
                        Department of Public Health
                        Southern Connecticut State University
                        144 Farnham Avenue
                        New Haven, CT 06515

APPLICANTS NAME:_________________________________________________________
                      Last, Family or Surname         First        Middle

ADDRESS:___________________________________________________________________
           Street Address            City/State          Zip Code

Social Security No. __ __ __ - __ __ - __ __ __ __

Under the provisions of the Family Rights and Privacy Act of 1974, you may decide whether
letters of recommendation written at your request are to be held confidential or whether they are
to be available for your personal inspection. Check one of the following statements and place
your signature in the space provided so that the referee will be advised of your choice.

______    Confidential file. I grant permission for this letter of recommendation to be held
          confidential by Southern Connecticut State University.

______    Open file. I retain the choice of having letters of recommendation available to me.

                                                ______________________________________
                                                               Signature of Applicant
_____________________________________________________________________________
[This section to be completed by the individual making the recommendation]
You may wish to make additional comments by letter. If so, please attach your letter to this form
so that the Department may identify the applicant’s choice with respect to the right of access
under the Family Educational Rights and Privacy Act.

Please note that while the applicant may have waived his/her right of access under the Family
Educational Rights and Privacy Act, in some circumstances this letter may be subject to
disclosure under the provisions of the Connecticut Open Records Act. Please mail this
recommendation directly to Southern Connecticut State University at the address noted above.
1. Knowledge of the Applicant
      Approximately how long have you known this applicant? ____months ____years
      How well do you feel you know the applicant? ____ well ____very well
      What was the nature of your contact(s) with applicant? _______________________
      Teacher _____ Research Advisor _____ Major Advisor _____ Employer _____

         Other (specify):_______________________________________________________
                                                            Please complete reverse side
2. Evaluation: In comparison with other students in the same field who have the same
   amount of experience and training, I rate this person as follows:

           Evaluation Criteria               Top       Top       Top       Upper       Unable
                                             5%        10%       20%        50%        to Rate
Knowledge base in public health
Ability to grasp new concepts
Originality, intellectual creativity
Mathematical and logical thought
Written expression
Oral expression
Ability to work with others
Perseverance toward goals
Ability to meet deadlines

3. Recommendation: Considering this applicant’s academic record, special abilities, ambition
           and determination, please indicate your recommendation:

    ______ Recommend Strongly                         ______ Recommend with Reservation

    ______ Recommend                                  ______ Cannot Recommend

4. Please add any comments which you believe will assist the Admissions Committee in
   assessing the applicant’s potential to successfully pursue graduate study in public
   health.




Name of Referee (please print): ___________________________________________________

Signature: ____________________________________________________________________

Title: ________________________________________________________________________

City, State, Zip Code: ___________________________________________________________

Phone Number: (        )______________________________________ Date ________________


                                                                                       reclet.frm
                              SOUTHERN CONNECTICUT STATE UNIVERSITY
                               SCHOOL OF HEALTH AND HUMAN SERVICES
                                   DEPARTMENT OF PUBLIC HEALTH
                                          M.P.H. PROGRAM
                                     PROFESSIONAL EXPERIENCE
                                            (Please list most recent first)

         Name: _________________________________________________________                 Date
         submitted ___________

         Social Security No. __ __ __ - __ __ - __ __ __ __

      Position/Title                Employer Name                   Address   Phone   Dates of Employment



Responsibilities:




      Position/Title                Employer Name                   Address   Phone   Dates of Employment



Responsibilities:




      Position/Title                Employer Name                   Address   Phone   Dates of Employment



Responsibilities:
      Position/Title   Employer Name   Address    Phone              Dates of Employment



Responsibilities:




      Position/Title   Employer Name   Address    Phone              Dates of Employment



Responsibilities:




      Position/Title   Employer Name   Address    Phone              Dates of Employment



Responsibilities:




      Position/Title   Employer Name   Address    Phone              Dates of Employment



Responsibilities:




                                                 proform.doc., revised 2002
                                       SCSU DEPARTMENT OF PUBLIC HEALTH
                                       M.P.H. ADMISSION SCREENING MATRIX

Applicant: ____________________________________________ M _____ F_____ Date ___________

Current Position: __________________________________ Social Security No. __ __ __ - __ __ - __ __ __ __

Cohort Year (Entering): _______ Cohort: FT_____ PT_____          Faculty Reviewer _________________

 For Committee Use                              TO BE COMPLETED BY APPLICANT
       Only                                            (Please print legibly)
                       1. Academic Degrees:
    4.0 – 3.6 (5)
    3.5 – 3.2 (4)           Undergraduate degree: Overall Grade Point Average = __________
    3.1 – 2.8 (3)                                 Major Grade Point Average = __________
    2.7 – 2-4 (2)
    2.3 – 2.0 (1)           Graduate degree: Grade Point Average = __________
    Excellent (5)      2.   Professional/Internship/ Volunteer Experience: ( list by title, agency, e.g.,
   Very Good (4)            Coordinator of Outreach Services at Fair Haven Clinic)
      Good (3)
       Fair (2)
       Poor (1)
    Excellent (5)      3.   Academic Preparation: ( list by college, degree, year graduated and major)
   Very Good (4)
      Good (3)
       Fair (2)
       Poor (1)
    Health and/or      4.   Certifications and/or Licenses: (list all and year earned)
       Medical
   Certifications or
    Licenses (3)
    Excellent (5)      5.   Personal Essay: (Summarize three (3) key points)
   Very Good (4)
      Good (3)              a. ___________________________________________________________________
       Fair (2)             b. ___________________________________________________________________
       Poor (1)             c. ___________________________________________________________________
    Excellent (5)      6.   Recommendations: (List by name and title)
   Very Good (4)
      Good (3)              a.   ___________________________________________________________________
       Fair (2)
       Poor (1)             b. ___________________________________________________________________
                       7.   Outstanding Personal Attributes/Recognitions: (list special recognitions, honors and
    Excellent (5)           awards, including year awarded)
    Very Good (4)
      Good (3)
       Fair (2)
      Poor (1)         APPLICANT: DO NOT WRITE BELOW THIS LINE
                       Acceptance_____                Wait List_____             Conditional Acceptance_____
 Admission
 Decision              Denied _____

 Total Points
 /33
                  SOUTHERN CONNECTICUT STATE UNIVERSITY
                      DEPARTMENT OF PUBLIC HEALTH

                           MASTER OF PUBLIC HEALTH (M.P.H.)


                         Quick Checklist for U.S. Applicants

         (International Applicants See Quick Checklist for International
                                  Applicants)



I.        Submit each of the following to the Graduate School:

       ___Completed Graduate School Application and $50.00 processing fee.
       ___Official copies of all academic achievements in each college, university, and
          professional school attended. Pertains to degrees and individual courses. A
          diploma is not sufficient.

II.       Submit to the Granoff Student Health Center unless born prior to January 1,
          1957, medically exempt (with signed physician’s note), or exempt for
          religious reasons (with signed note from clergy). Information required for
          course registration.

       ___Proof of immunization against Measles (Rubeola). One injection at 12 months of
          age or older and on or after January 1969, and a second injection after January 1,
          1980. Dates of immunizations must be included on documentation.
       ___Proof of immunization against German Measles (Rubella). One injection after 12
          months of age. Dates of immunizations must be included on documentation.
       ___Proof of immunization against Meningitis for those intending to live on campus.

III.      Submit to the Coordinator of Graduate Studies in the Department of Public
          Health:

       ___Personal Essay.
       ___Two letter of recommendation forms from professionals who can attest to your
          readiness for graduate study in public health. Formal letters, in addition to the
          forms, are encouraged and should be specific to your academic strengths and
          weaknesses.
       ___M.P.H. Screening Matrix form–a summary sheet of grades, degrees, experiences,
          etc.
       ___Chronology of Professional Experience Form or updated resume´.


       Note: Admission decisions are made only after all documents in categories I & III
       have been submitted to the appropriate University offices.
                       SOUTHERN CONNECTICUT STATE UNIVERSITY
                           DEPARTMENT OF PUBLIC HEALTH
                                MASTER OF PUBLIC HEALTH (M.P.H.)

                            Quick Checklist for International Applicants:

I.         Submit each of the following to the Graduate School Office:

       ___Completed Graduate School Application and $50.00 processing fee.
       ___Certified copies and certified English translations of all academic achievements in each
          college, university, and professional school attended. A diploma is not sufficient.
       ___Certified evaluation of foreign transcripts and credentials (course-by-course with grades) from
          an independent service recognized by the National Association of Credential Evaluation
          Services (NACES). A list of these agencies is enclosed.
       ___Grade point average for undergraduate study of at least “B.” Equivalence= 80.0 Chinese
          institutions; 1st Class or Division from Indian institutions; and, upper 2nd Class Honors from
          British institutions. Other grading systems will be evaluated by a certifying agency.
       ___TOEFL (Test of English as a Foreign Language), if native language is not English, scores of
          at least 550 written/213 computer. TOEFL are valid for only two years. In place of the
          TOEFL score, English as a Second Language Certificate ELS 109 may be used.
       ___File documentation (official bank statement) verifying that financial resources are available or
          guaranteed for the first calendar year at SCSU (see Information for Foreign Graduate
          Applicants, enclosed).

II.        Submit to the Granoff Student Health Center unless born prior to January 1, 1957,
           medically exempt (with signed physician’s note), or exempt for religious reasons (with
           signed note from clergy). Information required for course registration.

       ___Proof of immunization against Measles (Rubeola). One injection at 12 months of age or older
          and on or after January 1969, and a second injection after January 1, 1980. Dates of
          immunizations must be included on documentation.
       ___Proof of immunization against German Measles (Rubella). One injection after 12 months of
          age. Dates of immunizations must be included on documentation.
       ___Proof of immunization against Meningitis for those intending to live on campus.

III.       Submit the required forms to the Coordinator of Graduate Studies in the
           Department of Public Health:

       ___Personal Essay form.
       ___Two letter of recommendation forms from professionals who can attest to your readiness for
          graduate study in public health. Formal letters, in addition to the forms, are encouraged and
          should be specific to your academic strengths and weaknesses.
       ___M.P.H. Screening Matrix form–a summary sheet of grades, degrees, experiences, etc.
       ___Chronology of Professional Experience Form or updated resume´.

Obtaining the I-20.

       The I-20* will be forwarded to you only after:

            1. All documents required by the Department of Public Health and Graduate School have
               been received (see categories I & III above).
            2. The Department of Public Health has sent you a letter of acceptance.
            3. The Graduate School Dean has sent you a letter of acceptance.

*      If admitted, two copies of the I-20, a Student Copy and School Copy, will be mailed you. You
       must submit both copies to the VISA office in your country. If you are already in the U.S., only
       the Student Copy of the I-20 will be mailed to you.

       Note: Admission decisions are made only after all documents in categories I & III have been
       submitted to the appropriate University offices.

								
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