Global Health Certificate Course Plan

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In order to be granted the certificate (and have the certificate completion noted on the transcript), the student must notify the certificate’s Academic Administrator stating his/her intention to complete the certificate and then again once all requirements have been satisfied. This form should be completed before the first course is taken (for non-degree students) and no later than before the 3rd class is taken (for degree seeking students). Complete both pages of this form. All JHU students must take the certification for credit and letter grade.

Please complete this form electronically and return it via email to the certificate's Academic Administrator (Karla McCarthy kmccarthy@jhu.edu) as an email attachment. If you need to mail the form please mail it to Karla McCarthy, Department of International Health, 615 N. Wolfe Street, Rm E8516, Baltimore, MD 21205

Student’s name as it should appear on the certificate of completion.

First Last

Certificate for credit

Middle

If Degree student at JHSPH please choose degree and department: (Attending JHSPH)

MPH Part-time MPH MSPH MHS MHA PhD DrPH ScD

If JHSPH, specify home Department

(Attending other schools) Carey JHMI SON SAIS Homewood Gender: M F

Specify Degree

JHED ID Hopkins ID (found in ISIS):

Name of Recipient/Addressee First Last

(required by Federal Express)

State/Department/Province

Country

Local Telephone

Street Address

Floor/Suite/Room (if applicable)

City

Zip or Postal Code

Email Address (email address that is currently and will continue to be in effect for at least 3 months)

Global Health Certificate Course Plan

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Provide information for all the courses you’ve completed or are planning to complete. Include all information requested except the Grade column (shaded area).

Required Courses Course #  Course Name  Term  # 

Credits Academic 

Year Official Use only Grade 

220.601  Introduction to International Health 

221.688  Social and Behavioral Foundations of Primary Health Care 

223.680  Global Disease Control Program and Policies 

Elective Courses Course #  Course Name  Term  # 

Credits Academic 

Year Official Use only Grade 

For Official Use ONLY:

Feedback Report submitted on

Date of completion

Date sent for CAS approval

Date certificate is mailed

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