Obesity Prevention in Public Health Course
August 15-20, 2010

Application:

To apply for the 2010 Obesity Prevention in Public Health Course please complete the following:

Letter of Support, Resume and Statement of Intent:

To complete your application, please upload the following documents

• a letter from your agency sponsor supporting your time away from work to attend the course and the payment of course fee, if agency is defraying expenses
• a current resume or curriculum vitae
• a one page statement indicating the basis for your interest in attending the course (required only if you are NOT a CDC DNPAO 805 funded state program)

Please complete all fields.

Contact Information

Firstname:    Lastname: 

Job Title: 

Agency/Institution 

Department/Division 

Work Address

City    State    Zip 

Work Phone:    Work Fax:   

Work Email: 

Home Phone: 

Do you need special assistance or ADA accessible accommodations?  No Yes

Select documents to upload

Agency sponsor letter:
Resume or CV:
(If you are NOT a CDC DNPAO 805 funded state program, please provide an Interest Letter)
Interest Letter:

Please read the statement below:

I understand the 2010 Obesity Prevention in Public Health Course is designed primarily for Public Health Practitioners working in obesity prevention programs. I assure that if I am accepted and agree to attend, I will participate in and complete the full course. I also understand that no refunds will be given if I withdraw from the course after August 2, 2010.

I agree  Date: