MOPHA | Edna Dell Weinel Scholarship
Missouri Public Health Association
722 E. Capitol Avenue
Jefferson City, MO 65101
573-634-7977
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Complete only for Edna Dell Weinel Scholarship
Name
*
Email
*
Address
State
Home Phone
*
City
Zip
Place of Employment:
Employers Address
Employers State
Current Title
Employers Phone
Employers City
Employers Zip
Person who will always know how to contact you:
Name
*
Address
State
Phone
*
City
Zip
MPHA INVOLEMENT
Are you a current MPHA member?
Yes
No
If yes, how long have you been a member?
Describe your involvement or participation in MPHA. Include all MPHA committees and offices you have served.
ACADEMIC BACKGROUND
College/University/
Other Program
Years
Enrolled
Degree/Certification
Received
CURRENT PUBLIC HEALTH ACADEMIC TRAINING
Program Where Currently Enrolled:
Address
City
State
Zip
Degree Goal:
Number of hours completed toward degree:
Copy of official transcript required if applying for college/university class:
PUBLIC HEALTH EXPERIENCE
(Include the following information for each work experience.)
Employer 1:
Dates of Employment:1
Position:
Brief Description of Responsibilities:
Employer 2:
Dates of Employment:2
Position:
Brief Description of Responsibilities:
Employer 3:
Dates of Employment:3
Position:
Brief Description of Responsibilities:
VOLUNTEER/COMMUNITY INVOLVEMENT
(Include the following information for each organization.)
Organization 1:
Dates of Service:
Brief Description of Responsibilities:
Organization 2:
Dates of Service:
Brief Description of Responsibilities:
Organization 3:
Dates of Service 3:
Brief Description of Responsibilities:
Describe your most gratifying and successful accomplishments (personal and professional).
Explain how the scholarship would help you further your public health career.
Explain your commitment to public health in Missouri now and your plans after completing your public health related education.
List the event, location, date and estimated costs of your request:
For continued education meetings, seminars, conferences, etc., describe specifically how the event will benefit your professional development and enhance your contribution to the public health field:
Describe your need for financial assistance from this scholarship (i.e. loss of financial support from your employer for education activities, limited personal resources for professional education, etc.) Include a description of other financial resources to be used in achieving your continuing education plan or degree:
Once your application has been completed and submitted, you will receive an email requesting additional required documentation