Skip to main content

Health Program Application

Application for the Spring semester
Student demographic and academic status
Last Name: First Name:
Is there any other name your records could be under?
UH PeopleSoft ID Number: Date of Birth (MM/DD/YYYY):  
Gender:   Male   Female   Transgender
Permanent Mailing Address:
City:   State:  Zip:
Home Phone:    (713-743-XXXX) Cell Phone:    (713-743-XXXX)
Email Address: Offical program correspondence is with UH email address only. (Please confirm that you have entered email address correctly).  
Check your classification:   Sophomore   Junior   Senior
Are you a United States Citizen?   Yes   No
Predominant Ethnic Background (Federal law requires the University to report ethnicity of all U.S. citizens and resident alliens).
Hispanic
African American
White
Asian/Pacific Islander
Native American
Other
Are you or have you been a member of the U.S. military?
Yes, currently active
Yes, not currently active
Yes, currently in reserves
No, I am not nor have been in military
What is your overall GPA?   UH GPA:  
What semester is the start of your senior year (MM/YYYY)?  
Are you enrolled in BSH with emphasis on Public Health?   Yes   No
If no, what is your major?  
Please list three references:
Please be sure to enter correct email address for each reference so that your recommenders are able to send back reference information.
Full Name
Relationship
University/Company
Phone
Address
Email
Full Name
Relationship
University/Company
Phone
Address
Email
Full Name
Relationship
University/Company
Phone
Address
Email
Upload your current transcript:
Please upload only pdf file.

Upload 1-2 page goal statement:
Please upload only pdf file.

 
  I agree with the terms and conditions of the acknowledgements. Click here to view the acknowledgements.
 

Enter Text (case is not sensitive):
Click the SUBMIT button to finish.