Epi-Assist Interest Form
The University of Delaware is proud to introduce a NEW program, known as Epi Assist. Epi Assist is a team of student volunteers, within the university, who will be given the opportunity to gain hands-on experience in the field of public health.
 
Students will be assisting state and local health departments and other agencies with outbreak investigations, disasters and emergencies, community health assessments, and other projects to provide surge capacity and expert assistance.
Sign in to Google to save your progress. Learn more
Are you currently a UD student? (you must be a UD student to continue) *
Personal Information
First Name *
Last Name *
Phone Number *
UD affiliated E-mail *
Student ID # *
Do you have available transportation to an Epi Assist activity *
Are you willing to drive a carpool *
Education
*
Major or Program *
Expected graduation year *
Previous Experience
What experience have you had? *
Required
Length of experience: *
Have you been involved in outbreak investigation, emergency response/exercise? *
Languages other than English?
Previous Trainings *
Required
Emergency Contact
First name *
Last Name *
Phone Number *
Relationship *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of University of Delaware. Report Abuse
Google Forms