MATERNAL AND CHILD HEALTH CONCENTRATION
COMPLETION OF MCH REQUIREMENTS
This form is filled out after the student has been officially admitted to and completed the Maternal and Child Health Concentration. It
verifies that the student has fulfilled all requirements of the concentration and allows official acknowledgement at graduation.
“Fulfilling the requirements” is based on the opinion of the Maternal and Health Concentration faculty member on the student’s
advisory committee using guidelines listed in MCH documents below. This form is included in the student’s official record.
Name of Student: ______________________________________________________________________
Degree program: _________________________ Campus: _____________________________________
_____________________________________________________________________________________
PRINTED name of Maternal and Child Health Concentration faculty member on student’s advisory committee
THIS SECTION IS TO BE COMPLETED ONLY BY CONCENTRATION FACULTY MEMBER ON THE STUDENT’S ADVISORY COMMITTEE
INSTRUCTIONS:
Put a checkmark on the line for the requirements of the Maternal and Child Health
Concentration that has been MET: (leave blank those which have not yet been completed)
_____ PH 5301: MCH Core Training Seminar I (3 credits) has been successfully completed
_____PH 5311: MCH Core Training Seminar II (3 credit) has been successfully completed
___________ A minimum of 6 additional credit hours have been successfully completed in courses
identified as MCH Electives. MCH electives chosen should be based on a discussion and mutual
decision between the MCH student, his/her MCH advisor with input from the MCH Core faculty as needed.
Alternative electives can be selected with written approval of the MCH Director
Record below the course numbers that you judge meet the Maternal and Child Health Concentration
criteria for this student.
________________________________________________________________________________________
________________________________________________________________________________________
____
____
The practicum has been completed in a setting and topic relevant to maternal and child health.
AND
A thesis or dissertation has been completed on a topic relevant to maternal and child health or the
Capstone Course and exam has been successfully completed.
______________________________________________________
SIGNATURE of Maternal and Child Health Concentration faculty member
_______________________
Date
on the student’s advisory committee
SUBMIT THIS FORM TO: LATAWNYA PEACHY, LATAWNYA.D.PEACHY@UTH.TMC.EDU or
FAX: 214-648-1081
THIS FORM MUST BE SUBMITTED BY OFFICE OF STUDENT AFFAIRS GRADUATION DEADLINE
Completion of Requirements MCH– checklist graduation-Rev. 8/16/11