International Program in Public Health Leadership (IPPHL) 2017 Application
Thank you for applying to the International Program in Public Health Leadership (IPPHL). Application review will be completed after the March 31st priority application deadline.

After successfully completing the form, you will receive a confirmation email. If you do not receive a confirmation email concerning your application within 24 hours, we may need to send you a request for additional information. Click here for a PDF version of this form: https://evans.uw.edu/sites/default/files/IPPHL%20Application.pdf

If you have any other problems or concerns with this form, please email our office at ipphl@uw.edu.

Email address
Applicant's full name
Your answer
Applicant's preferred name, as it will appear on your name badge
Your answer
Applicant's preferred pronouns
Your answer
Applicant's Country of Citizenship
Your answer
Applicant's phone number
Your answer
Applicant's current position/job title
Your answer
Name of Organization and Program/Team
Your answer
Applicant's Address Line 1
Your answer
Applicant's Address Line 2
Your answer
City or local government unit
Your answer
State/Region
Your answer
Zip/Postal Code
Your answer
Will you need disability or other learning accommodation?
If yes, please describe
Your answer
Do you have dietary restrictions or allergies? (Standard menus include vegetarian and gluten-free options.)
If you have a dietary restriction or allergy, please in detail the items you cannot eat, and the severity of the restriction (for example, does the smell disturb you, can you consume trace amounts, etc.)
Your answer
Number of years you have worked in the public health sector
Your answer
Number of years in your current position?
Your answer
Resume/CV
Please copy and paste the text from your current resume or curriculum vitae.
Your answer
Please copy and paste below a letter of recommendation from your manager or other equivalent leader within you organization.
That letter should include: 1) why IPPHL is a good opportunity for you; 2) a statement of support for your travel and time away from work for the two-week residency in Seattle and the final seminar in Rome; and 3) a statement of willingness to participate in elements of the program that require input from your organization.
Your answer
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