Skip to content

Deep South Center for Occupational Health & Safety

School of Public Health

Home
About
People
SERRS with SouthON
Continuing Education/Calendar 2025
Conferences & Summer Programs
Faculty Research
- Faculty Research listing
Pilot Project Research/Call for Proposals 2025
- PPRT Awardees 2019 – 2024
Contact

Public Health Influencer Summer Institute

Public Health Summer Program

Full Name: *

High School: *

Home Address: *

Which grade will you be entering in the Fall of 2025? *

GPA (If unknown, please put N/A)

State: *

Zip Code: *

Student Cell Phone: *

Student Email: *

Parent Email: *

Emergency Contact: *

Emergency Contact:

First Name

Last Name

Emergency Contact Cell Phone: *

Emergency Contact Email: *

Emergency Contact Relationship to You (Parent, Grandparent, Guardian, etc): *

Why are you interested in the program? (Minimum of 150 words; Maximum 250 words): *

0 of 250 max words

Once you learn more about public health, how do you plan to be a public health influencer in your social network? (Minimum of 150 words; Maximum 250 words): *

0 of 250 max words

Which social media platform do you use most often?

Facebook

Instagram

TikTok

OtherOther

Have you ever attended a course in your HS focused on health?

Yes

No

What was the class subject or topic focus?

How did you learn about this program?

Teacher

Parent

Website

Flyer

Visit from UAB representative

Social Media

OtherOther

If you are human, leave this field blank.

This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Accessibility Toolbar

Theme: Maisha Lite

UAB the University of Alabama at Birmingham home

Login
|
Privacy
|
Terms of Use
|

UAB is an Equal Employment/Equal Educational Opportunity Institution dedicated to providing equal opportunities and equal access to all individuals regardless of race, color, religion, ethnic or national origin, sex (including pregnancy), genetic information, age, disability, religion, sexual orientation, gender identity, gender expression, and veteran’s status. As required by Title IX, UAB prohibits sex discrimination in any education program or activity that it operates. Individuals may report concerns or questions to UAB’s Assistant Vice President and Senior Title IX Coordinator. The Title IX notice of nondiscrimination is located at uab.edu/titleix.