RegistrationForm FT CHT

Office of the Registrar ● 1310 Club Drive ● Vallejo, CA 94592 ● phone: 707‐638‐5984 ● fax: 707‐638‐5267 ● email: tucareg...

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Office of the Registrar ● 1310 Club Drive ● Vallejo, CA 94592 ● phone: 707‐638‐5984 ● fax: 707‐638‐5267 ● email: [email protected] ● website: http://tu.edu

REGISTRATION FORM Academic Program:

□ DO □ MSMHS □ Pharmacy □ Education □ Joint MSPAS/MPH ☒ Public Health

Name

Class of

Student ID#

_

SEMESTER (PLEASE SELECT ONE): □ SUMMER ☒FALL □ SPRING YEAR: _2012___ Full-Time Enrollment – Global Health Track COURSE NUMBER

COURSE NAME

UNITS

Core Courses PH 607 1A

Biostatistics

3

PH 608

Behavioral and Social Aspects of Public Health

3

PH 648

Environmental Health

3

_

3

_

Track Course PH 620

Essentials of Global Health

Total Units This Semester

12

I agree to abide by the rules and regulations of Touro University California, and to uphold Touro University California standards of social and academic conduct at all times while on campus and while participating in clinical rotations. Student Signature

Date

For Office Use Only:

Date Received by Registrar’s Office Bursar Approval

Date Registration Completed

Processed by

Program Approval Name of Authorized Program Representative (please print) Signature Office of the Registrar – Registration Form

Date 2/8/12 VJ