NCCU Partners Public Health Application

Personal Information

Name*

First Middle Last

Email address*

Phone number*

Current mailing address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Permanent mailing address (if different from above)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Race/Ethnicity*

More than one can be chosen.

African American
Asian/Pacific American
Latino/Hispanic
Native American/American Indian
White/Caucasian
Other

Please indicate tribal enrollment*

Please indicate ethnicity*

Gender*

Female
Male
Non-binary
Transgender
Prefer to self-describe
Prefer not to say

Please describe your gender identity or expression:

Citizenship/Residency*

Applicants must be U.S. Citizens or Permanent Residents (Green Card holder)

U.S. Citizen
Permanent Resident

Do you have a valid N.C. driver's license?*

Your Banner ID number*

For financial purposes only

Education

Status at time of application*

Freshman
Sophomore
Junior

Expected graduation date*

Current overall GPA*

Major(s)*

Minor(s)

Relevant college courses*

e.g. Biology, chemistry, math, and/or public health courses. Please separate entries with a comma.

Letter of Recommendation - Faculty Reference #1

Name*

First Last

Department*

Email*

Phone*

Letter of Recommendation - Faculty Reference #2

Name*

First Last

Department*

Email*

Phone*

Letters of Recommendation*

It is your responsibility to request two letters of recommendation from NCCU faculty and instruct them to send directly to the program leaders. These must be emailed directly from the letter writers to the program directors Trinnette Cooper and Lahoma Romocki at coopert@email.unc.edu and lromocki@nccu.edu

I understand that my two faculty recommendations must be emailed by the writers to Trinnette Cooper and Lahoma Romocki.

Application Documents

Upload your current transcript(s)*

Drop files here or

Upload your personal statement*

Compose a 1-2 page personal statement explaining why you are applying for this internship, your research experience, and your educational and career goals. Statements should be typed in 12-point font, single spaced, with 1-inch margins.

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