MPH Prospective Student Form

Morehouse School of Medicine

Master of Public Health Program

Prospective Student Information

First Name *

Last Name *

Street Address

Address Line 2

City

State

Zip Code

Email Address *

Phone Number

How did you hear about us? (Please check all that apply): *

Alumni

Open House/Informational Session

Graduate Fair/Conference

Internet/Search Engine

Social Media (Facebook, LinkedIn, Twitter, etc.)

Morehouse School of Medicine Website

Other (please specify) Other (please specify)

Classification (Please check all that apply): *

Recent College Graduate (graduated within the past 3 years)

College Graduate with Less than 2 Years Work Experience

Working Professional

Former Working Professional

Physician Resident

Undergraduate Student (expected graduation month & year: Undergraduate Student (expected graduation month & year: