Membership in the University of Pennsylvania
Center for Public Health Initiatives
APPLICATION FORM
Please send a (1) Biosketch (or curriculum vitae) and (2) Confirmation of appointment at
Penn along with the completed form below to Wendy Voet, Administrative Director at
wvoet@exchange.upenn.edu or fax to 215-573-5311.
All Affiliations with the CPHI will need to be reviewed and updated every 2 years.
ALL OF THE INFORMATION COLLECTED ON THIS FORM WILL BE USED TO DEVELOP A
PROFILE FOR YOU ON THE CPHI WEBSITE. PLEASE PROVIDE INFORMATION SO THAT
IT CAN EASILY BE USED IN THIS MANNER.
Name:
Title:
School/Department:
Mailing address::
Phone:
email address:
URL for personal home page, if applicable:
Please provide below or attach a short (100 words or less) profile statement about the
nature of your interest in public health and how public health interfaces with your current
roles and activities.
A. Brief biographical statement highlighting any current public-health related
activities:
B. Public Health Interests (keywords):
C. Select Publications
(above, please provide at least one (no more than four) publication (s)
relevant to the field of public health on which you were an author)
For the section below, please see the definitions for Senior Fellow and Associate, before
making selections.
Are you interested in being considered for:
_____ Senior Fellow (see definition attached below)
_____ Associate (see definition attached below)
_____ Adjunct Fellow (see definition attached below)
If applying to be a Senior Fellow:
1. Do you plan to participate regularly in faculty meetings, seminar
series, retreats, and/or other Center events?
____ Yes
____ No
2. How do you plan to collaborate significantly with other Center Faculty
in research and scholarship? Please be brief.
3. What types of activities do you plan to arrange that advance the field
of Public Health at Penn? Please be brief.
If applying to be an Associate:
1. How do you plan to contribute 100 hours of time to CPHI-related
activities per year? Please note that 100 hours can include public health
meeting and research time.
Definitions of Affiliations with the CPHI:
There are three levels of faculty association with CPHI.
a. Senior Fellows
b. Associated Fellows
c. Adjunct Fellows (those otherwise meeting the criteria for Senior or Associated
Faculty but who are not employed faculty members of the University of
Pennsylvania)
Senior Fellows
The criteria for the rank of Senior Fellow in the Center for Public Health Initiatives are:
1. Senior Fellows must be on the Standing or Associated Faculty of the University of
Pennsylvania.
2. Senior Fellows must do a significant portion of their academic work in the area of public
health, whether teaching, research, practice, consultation or a combination thereof.
Public Health should be central to their professional identity.
3. Senior Fellows must participate in faculty meetings, seminar series, retreats, and/or other
Center events.
4. Senior Fellows collaborate significantly with other Center Faculty in research and
scholarship.
5. Senior Fellows serve as leaders in public health at Penn, proactively arranged activities
that advance the field of Public Health at Penn.
The title ‘senior fellow’ is independent of rank in the faculty member’s primary school.
Associates
The criteria for the rank of Associate of the Center of Public Health are:
1. Associates are involved in public health at some level in their work.
2. Associates participate in Center associated activities at least 100 hours a year, which can
include their public health associated research efforts.
3. Associates participate in some faculty meetings, seminars, and/or other Center events.
4. Associates should be available for individual lectures in the courses, advising for an
occasional MPH capstone project, service on committees, related MPH work, teach
continuing education for public health professionals, and/or participate in collaborative
research or scholarship with Senior Fellows or other Center personnel.
5. Associates are requested to note their relationship to the Center for Public Health
Initiatives on publications, presentations, or related activities when appropriate to the
subject matter.
6. Associates are to provide an update of their Center for Public Health Initiative activities
and public health teaching and research interests annually and be reappointed every two
years.