*Application Term

Submitted Flag

Yes

Are you applying as an applicant for courses through any of the following programs?

This application is the first step in the Special Standing process. For applicants who have never applied to Rollins School of Public Health as a non-degree student OR have not done so in the past five years, you must complete and submit this application. Emory University employees and graduates interested in registering for special standing courses are also required to submit this application for admittance. After completing the application, you will receive a confirmation of your submission and instructions on how to submit your academic transcript. Please also review the special standing webpage for additional details and requirements.

Please complete the information below. This application must be completed in one sitting.

Name

Prefix

*First Name (Given)

Middle Name

*Last Name (Family)

Suffix

Preferred First Name

Other Last Names Used

Addresses

*Permanent Address

Country

Street

City

Region

Postal Code

*Mailing Address

Country

Street

City

Region

Postal Code

Email Address

*Current Email

Telephone Number (include +country code)

*Mobile

Biographical Information

*Sex

While we understand that your sex may not necessarily be binary, this information is required for reporting purposes to the U.S. Federal Government using these values only.

*Birthdate

*Birth Country

*Birth State

*Birth City

Citizenship Information

*Primary Citizenship

Dual Citizenship

Social Security Number (Providing your SSN is optional for the admission process, although it is mandatory if you wish to be considered for financial aid.)

Race/Ethnicity

Colleges and universities are asked by many groups, including the federal government, accrediting associations, college guides, and newspapers, to describe the ethnic/racial backgrounds of their students and employees. In order to respond to these requests, we ask you to answer the following two questions.

Definitions:

White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Black or African American: A person having origins in any of the black racial groups of Africa.
Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
American Indian or Alaska Native: A person having origins in any of the original peoples of North and South America (including Central America), who maintains cultural identification through tribal affiliation or community attachment.
Native Hawaiian or Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Are you Hispanic or Latino?

Yes

No

Academic History

Please enter the undergraduate institution where you have completed your bachelor's degree or its equivalent.

NOTE: You are required to submit an official bachelor's transcript for the special standing application. Instructions on submitting an official transcript can be found here.

*Undergraduate Institution Name

*Country

*State

*City

*Level of Study

*Start Date

*End Date

*Degree

*Degree Conferred Date

*Major

Second Major

Minor

Language

Yes, English is the primary language of instruction at this institution.

Work Experience

Please enter your most recent or current place of employment and position.

Employer Name

Country

State

City

Telephone

Job Title

Start Date

End Date

TOEFL Scores

International applicants are required to submit official TOEFL or IELTS scores. You can find more about the TOEFL requirement by visiting our International Applicants page.

If applicable, please indicate if you will be submitting TOEFL or IELTS scores.

Signature

Statement of Ethics and Integrity

By the submission of this application, I certify that the information provided in this application is complete and accurate. I acknowledge and agree that misrepresentation of credentials, including submission of inaccurate, falsified or plagiarized information is sufficient cause for terminating my application, revocation of all offers of admission and financial assistance and/or termination of enrollment.

Furthermore, I authorize the persons or entities to provide any relevant information to Emory University for use in evaluating my application for admission and waive any required notice to me. I understand and agree that all submitted application materials are the property of Emory University and will not be returned and that the application fee is non refundable under any circumstances.

During such time as I may be enrolled as a student, I will abide by the Honor Code and Code of Conduct and all relevant rules, regulations, practices and policies of Emory University as they may be changed during my continuance as a student.

*In place of your signature, please type your full legal name:

Equal Opportunity Policy:

Emory University is dedicated to providing equal opportunities and equal access to all individuals regardless of race, color, religion, ethnic or national origin, gender, genetic information, age, disability, sexual orientation, gender identity, gender expression, and veteran's status. Emory University does not discriminate in admissions, educational programs, or employment on the basis of any factor stated above or prohibited under applicable law. Students, faculty, and staff are assured of participation in University programs and in the use of facilities without such discrimination. Emory University complies with Executive Order 11246, as amended, Section 503 of the Rehabilitation Act of 1973, the Vietnam Era Veteran's Readjustment Assistance Act, and applicable executive orders, federal and state regulations regarding nondiscrimination, equal opportunity and affirmative action. Emory University is committed to achieving a diverse workforce through application of its affirmative action, equal opportunity and nondiscrimination policy in all aspects of employment including recruitment, hiring, promotions, transfers, discipline, terminations, wage and salary administration, benefits, and training. Inquiries regarding this policy should be directed to the Emory University Department of Equity and Inclusion, 201 Dowman Drive, Administration Building, Atlanta, GA 30322. Telephone: 404-727-9867 (V) | 404-712-2049 (TDD).

Special Standing Application

Statement of Ethics and Integrity