Declaration of Intent - Health Policy and Management Certificate Programs | Johns Hopkins

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Current JHU students who would like to pursue a certificate offered by the Department of Health Policy and Management should complete the declaration of intent form below. The form is important for supporting students, maintaining records, and ensuring requirements are met. As such, please submit the form as soon as possible.

First Name

Last Name

E-mail

Current BSPH Degree Program

Certificate Program Name

Certificate Program Start Term

ie. 1st Term, 2nd Term, etc.

Certificate Program Starting Academic Year

Please check the JHU catalogue for the certificate program to which you are applying and use the curriculum to complete this proposed schedule of courses.

Course Number	Course Name	Term Course will be Taken	Academic Year	Online or On-Campus	Number of Credits	Operations
Course Number	Course Name	Term Course will be Taken	Academic Year	Online or On-Campus	Number of Credits

Total Number of Proposed Credits to Complete Certificate Program

Date

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Declaration of Intent Form