Graduate Certificate in Water, Sanitation, and Hygiene

*SECOND YEAR STUDENTS ONLY*

Declaration Form This certificate is offered by the Rollins School of Public Health. Completion of the certificate requirements will be verified as follows:

• You have completed required WASH-related coursework, including one methods-related course and onebiology-related course.

• You have completed a WASH-related practicum AND are in the process of completing a WASH-relatedcapstone/thesis. Please include titles of practicums and draft titles of theses/capstones below.

• You will attend your Verification/Exit Interview where Dr. McGriff will review your transcripts to verify acumulative GPA of 3.3 or greater for all WASH courses and ensure that you have completed the minimumcredit hours for WASH-related coursework. Seminar attendance will also be discussed during your exitinterview.

The deadline for this form is January 15, 2019

Name: ________________________________________________________________ Today’s Date___________

Email: ________________________________________ Student ID: ______________

Department: BIOS BSHE EH EPI HPM GH GEH GLEPI

Other: ________________________

Expected graduation date (month / year):___________________

Is your practicum WASH related? Yes No Unsure*

Is your capstone/thesis WASH related? Yes No Unsure*

Practicum/GFE title and organization: _________________________________________________________

________________________________________________________________________________________

Faculty advisor for the WASH-related practicum/GFE**:__________________________________________

Agency/Organization (Practicum) _________________________ In-country supervisor__________________

Name of WASH faculty advisor for the WASH related- thesis/ capstone***:___________________________

Prior to today, have you ever submitted a Provisional Approval form for a course or practicum/thesis? Yes No

** If your practicum/GFE faculty advisor is not WASH faculty at Emory, please submit a provisional approval form to Dr. Joanne McGriff.

*** If your thesis/capstone faculty advisor is not WASH faculty at Emory, please submit a provisional approval form to Dr. Joanne McGriff.

Graduate Certificate in Water, Sanitation, and Hygiene

Please mark the courses you have taken below:

WASH-Related Courses: (Check all that Apply) BSHE 539 Qualitative Data Analysis (Andes, 3 hours) M EH 548 Research Methods for Studies of Water & Health (Levy, 3 hours) EH 549 Approaches to Water, Sanitation, & Hygiene Research (Levy/Freeman/Clasen, 2 hours) GH 522 Qualitative Research Methods (Hennink, 3 hours) GH 525 Qualitative Data Analysis (Hennink, 3 hours) GH 560 Monitoring & Evaluating Global Health Programs (Freeman, 3 hours) GH 565 Monitoring and Evaluation (Stein, 2 hours) INFO 530 Geographic Information Systems (Clennon, 2 hours) EH 546/GH580 Environmental Microbiology: Control of Food and Waterborne Diseases (Moe/Gangarosa, 2 hours)

B

GH516 Global Perspectives in Parasitic Diseases (Leon, 3 hours) EHS 750 Environmental Determinants of Infectious Disease (Levy, 3 hours) CEE 4803 Environmental Technology in the Developing World (Brown and Bergin, 3 hours) E CEE 6311 Microbial Principals in WASH (Brown, 3 hours) EH 570 Environmental and Occupational Health Policy (Clasen, 2 hours) EH 582/GH582 Global Climate Change: Health Impacts & Response (Liu, 2 hours) EH 590R Design, Delivery, and Assessment of WASH in Schools Programs (Freeman, 2 hours) EPI 540 Case Studies in Infectious Disease Epidemiology (Spaulding, 2 hours) GH529 Water and Sanitation in Developing Countries (Moe, 2 hours) GEH 571 Global Environmental Health Policy: Power, Science & Justice (Clasen, 2 hours) INFO532 Principals of Geographic Information Systems (Clennon, 4 hours) Provisionally Approved Class: (title and # credit hours) Provisional Approved Class: (title and # credit hours)

___________________________________________________ Student’s signature verifying the information above is accurate:

Forms should be placed in the mailbox of the WASH Certificate coordinator, Kathleen “Kat” Peters. Please e-mail kpeter5@emory.edu indicating that you have dropped off your form.

Graduate Certificate in Water, Sanitation, and Hygiene