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Prospective Student Inquiry Form

Submit Your Information To Us

Thank you for your interest in the Master of Health Administration programs at the University of Washington. Please fill out this form as completely as possible so that we may better assist you. You may also print form, fill it out off-line, and mail it to the Program Office.

Personal Information

First Name Middle Name Last Name

Degree(s) Held

Will you be an international applicant? * No Yes

* See our Application page for definition of “international applicant.”

Program Interest

MHA MHA/MBA MHA/MD MHA/MPA Executive MHA CPMM

Interested in applying for which year?:

Work Information

Title/Position

Department

Organization

Contact Information

Home Work

Phone

E-mail

Place of Legal Residence

City	State/Province
Country

Information Sources

Help us communicate better with other prospective students:

Where did you first learn about the UW MHA Programs?

Advertisement Brochure Colleague/Friend UW Catalog/Web site Internet Search Program/Dept. Web site Fair/Information Session Other

Please give us any additional information related to how you heard about us (I.e.: What advertisement or other source of information.)

Additional questions or comments

University of Washington | School of Public Health and Community Medicine | Department of Health Services

Equal Opportunity and Disability Accomodations

Contact: H-660 Health Sciences Building | Box 357660 | Seattle, Washington 98195 | phone: 206-543-8778 | fax: 206-616-3964