Master of Public Health Direct Entry Form

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PHHP Application Creation Type

PHHP External Application Source

Prefix/Honorific

First (Given) Name*

Middle Name

Last (Family) Name*

Chosen First Name

Suffix

Email Address*

What is your current institution?*

In which program are you currently enrolled?*

MPH Program Information

In which term will you begin the program?*

Which MPH program are you interested in?*

Required Attachments

Current Transcript*

An unofficial transcript can be accepted for review of your academic record, but a final, official transcript showing conferral of a bachelor's degree will be required after enrollment.

Biographical Information

Legal Sex*

Birthdate*

Country of Birth*

How do you describe yourself? (Optional)

Different Identity

What pronouns do you use? (Optional)

Other Pronouns

Have you ever been cited for academic violations?*

Yes

No

Are you currently a New York State Resident?*

How long have you been a New York State resident?*

Before enrolling in courses, you may be asked to provide certain documents that verify your New York State residency status. Please see the UB Graduate School website for more information.

Citizenship Information

Country of Citizenship*

Dual Citizenship

Are you a Permanent Resident of the United States?*

This program is available only to United States citizens and Permanent Residents. If you are an international student, you are required to apply in SOPHAS.

Before enrolling in courses, you may be asked to provide copies of certain documents to verify your U.S. Permanent Resident status. These documents may include your Green Card, your I-94 Arrival/Departure Card, and any petitions or applications that have been filed on your behalf. If applicable, you will receive specific details on these requirements after admission.

Contact Information

Phone Number*

Mailing Address*

Country

Street

City

Region

Postal Code

Permanent Address*

Same as Mailing Address

Country

Street

City

Region

Postal Code