Alumni Council Application Alumni Board Application Form Name * Required First Last Address * Required Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone * RequiredWhat is your degree from the UIC School of Public Health? * RequiredIf you have more than one, check all that apply. BA MHA MPH MS PhD DrPH Which division did you graduate from? * RequiredIf you have degrees from more than one division, check all that apply. Community Health Sciences Environmental and Occupational Health Sciences Epidemiology and Biostatistics Health Policy and Administration My degree is a BA or DrPH, so I wasn't in a division. Current EmployerEmployer Address * Required Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Work Phone Number * RequiredWork Email, if any Previous Positions * RequiredPlease tell us why you are interested in joining the UIC SPH Alumni Board. * RequiredWere you encouraged to apply for the Alumni Board? If yes, please list the name.Please attach your resume for review. * RequiredAccepted file types: doc, pdf. This iframe contains the logic required to handle Ajax powered Gravity Forms.