UNIVERSITY OF WASHINGTON, Department of Health Services 
EXTENDED MPH DEGREE PROGRAM 
Email:  uwedp3@u.washington.edu 
(206) 685-7580 
MPH PROJECT COMMITTEE APPOINTMENT CONTRACT 

This contract must be completed and returned to the Extended MPH Degree Program Office (uwedp3@u.washington.edu) before a student may register for ExDP Project (HSERV 598S) credits. Students should read the section entitled "Project Option – Detailed Guidelines" online and follow the required project steps.

DIRECTIONS FOR USING THIS FORM 
1) The student copies and pastes the below into their email.  Fill out the email template at the appropriate blanks.
2) The student uses their UW email account to send the form by email to their chair/committee members and to ExDP at uwedp3@u.washington.edu
3) The chair/committee member reviews and states their approval of the content/goals on the lower part of the form and sends the entire communication back to ExDP at uwedp3@u.washington.edu
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STUDENT

Student Name: 
Project Topic: 



The Chair must be an approved member of Graduate Faculty.  Please use the Graduate Faculty Locator (http://www.grad.washington.edu/gradfac/) to verify.  

Committee Member(s) can be agency or faculty members.



FACULTY

This topic has been approved and I have agreed to serve as this student’s: (Please Mark an ‘X” in One)
_____Committee Chair	
_____Committee Member
_____Agency/Community Preceptor

Name:
Department:
Address or Box Number:
E-mail:
Phone number: