Submission Form - Applicant Information
2023 Steve Wallace Health Policy Fellowship. 
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Email *
Name *
Degree, department, anticipated year of graduation
 *
Contact Phone Number *
Title of your submission *
Submission medium (e.g. essay, photo collage) *
How will you submit your entry? *
If your entry is selected, how should your name appear on a certificate and in print announcements?
 *
Selected winners will be asked to sign a release to grant to The Regents of the University of California permission to reproduce their name, identity, and winning submission in any publication or event of The Regents of the University of California intended for research, educational, marketing, promotional, fundraising, or other related use.
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