Occupational Health & Safety Section
American
Public Health Association
James
P. Keogh Memorial Scholarship Fund, 2005
STUDENT
APPLICATION
The Occupational Health and Safety Section
will be awarding scholarships that include registration for the 2005 APHA
Annual Meeting, (November 5 - 9, 2005, New Orleans, LA), a one-year membership
in APHA and $300.00 for conference expenses. We hope to strengthen the
participation of students and union representatives in APHA and our section. We
recognize that we need the involvement of workers and new health & safety
professionals to make our workplaces & communities healthy and safe.
AWARD:
The value of each award is $500.00. The
Section will directly pay the annual meeting fee & one-year membership to
APHA with primary membership in the Occupational Health & Safety Section.
Each awardee will then receive $300.00 that can be used to cover
transportation, lodging, and meals. Awardees will be responsible for providing the
remainder of funds necessary to cover these expenses. At the Annual Meeting we
will pair each awardee with a section member with similar interests.
ELIGIBILITY REQUIREMENTS:
Students
Student applicants should be enrolled in a
graduate-level program that can lead to work in the occupational health &
safety field. (Examples include medicine, nursing, public health, toxicology,
law, industrial hygiene, safety, ergonomics). Eligible applicants MUST be
students at the time of the Annual Meeting.
Please submit your application (by
regular or email) by July 31, 2005 to:
Karen B. Mulloy
MSC 10 5550, 1
Telephone: (505) 272-4027
Email: kmulloy@salud.unm.edu
(Email preferred.)
THIS
APPLICATION FORM CAN BE REPRODUCED!
Occupational Health & Safety Section
American Public Health Association
James P. Keogh Memorial Scholarship Fund Application: FOR STUDENTS
Please print neatly or type:
Name: _________________________________________________________________
Street Address:
________________________________________________________
___________________________________________________________
City, State, Zip
__________________________________________________________
Telephone: Day
(____)___________________________________________________
Evening
(____)_________________________________________________________
Telephone after May 1st (if different)
(____)_________________________________
Fax (____)____________________________________________________
Email
__________________________________________________________
************************************************************************
Name of
University_______________________________________________________
Department:
____________________________________________________________
Degree Program:
________________________________________________________
Professional Field: (occ nurse, IH, safety
engineer, medicine, etc.)_____________
Anticipated Graduation Date:
_____________________________________________
Optional : Sex:______ Ethnic
Background:________________________
Please complete the following information
for a Faculty Member we can contact as a reference:
Name
____________________________________________________________
Telephone
(____)___________________________________________________
Email
__________________________________________________________
Please answer the following questions. (You
can add additional pages if you need to, but a concise response is welcomed.)
1). Please briefly explain your current
studies in occupational health & safety. Note any topics or projects that
you have found particularly exciting.
2) How do you think your discipline can
improve health & safety conditions for workers?
3). Please describe what your ideal job
would be after graduation.