Department of Health Science

Health Science Major

Health Education Working Fellowship (HEWF) Application

Application Form _________________
                              Semester  |  Year

Name: __________________________________

E-mail address: ___________________________

Local Address:

_____________________________________________________________

City: __________________________ State: __________ Zip ___________

Home Address:

_____________________________________________________________

City: __________________________ State: __________ Zip ___________

Phone Numbers:

Cell: _______________________ Home: ________________________

Health Science Concentration:

_________________________________________________

Projected graduation date: _____________

Overall GPA: ______ Health Science GPA: ________

Health Science Faculty References:

1) __________________________________________

2) __________________________________________

Health Science Advisor: _________________________________

*****The HEWF involves health promotion work with Dr. Jack D. Osman. Basic computer skills (word processing, file management, internet searches, e-mail, etc.) and quality communication skills are necessary. The recipient will receive $500 in return for 50-60 hours of health promotion work during the semester. Work hours are arranged around class schedules. The HEWF is renewable.

I affirm that the above information is accurate and grant permission for Dr. Osman to check with the above listed faculty.

Signature: _________________________________________

Date: __________________

Attach a one page, double-spaced, typed essay describing your qualifications and reasons for applying for the Health Education Working Fellowship. Return completed application and essay to: Health Science Department, Burdick Hall #141 by the end of the third week of the semester.

060408

Department of Health Science
Burdick Hall, Room 141

Hours: Monday–Friday, 8:30 a.m.–5 p.m.

Phone: 410-704-2637
Fax: 410-704-4670