Health Policy Honors Program Application

Complete form below and attach CV or resume

Sponsored By:

Contact:
Dr. Peggy Honore, Program Director
phono1@lsuhsc.edu
School of Public Health – Lions Bldg – Room 317
504-568-5912 (Office)
770-241-8570 (cell)

Name*
First Last
Cell Phone*
Emergency Contact Name & Number*
Email*
Anticipated Graduation Date*
MM slash DD slash YYYY
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Undergraduate Degree*
Undergraduate GPA*
Graduate Degree*
Graduate GPA*
Description of any Policy, Public Health, or Healthcare Experience*
Describe your interest in Health Policy*
If you have specific interest, please indicate below:
Policy Topic(s)
Disease/Condition
Social Determinants
(Optional) Preferences for Policy Placement Site
Upload your resume
Accepted file types: pdf, docx, doc, Max. file size: 50 MB.
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