Apply Complete the application below to be considered for entry into the PHIT 4 DC Program. Name(Required) First Middle Last Suffix Admission Term(Required)Fall 2024Please select the PHIT Course you are applying for (selection does not confirm admission):(Required)PHIT BootcampPHIT Experiential CoursePHIT Clinical Informatics* (must have completed the PHIT Experiential Course)Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Email(Required) Enter Email Confirm Email Date of Birth(Required) MM slash DD slash YYYY Gender(Required) Male Female Transgender Female Transgender Male Gender Variant/Non-Conforming Prefer Not to Answer DC Resident(Required)If you are not a DC Resident you may still be considered for the program if you are employed by a DC based business. Yes No Two Recent Pay Stubs(Required)Max. file size: 2 GB.Please ensure that your name and your employer's name are visible and remember to redact any personal or private information. Ethnicity(Required) Hispanic or Latino Not Hispanic or Latino Select one or more races to indicate what you consider yourself to be.(Required) Alaska Native American Indian Asian Black or African American Native Hawaiian Pacific Islander White Veteran(Required) Yes No Veteran ID(Required) Marital Status(Required) Single Married Separated Divorced Employment Status(Required) Unemployed Employed In DC Employed Outside of DC Name of Employer(Required) Job Title(Required) Academic Affiliation(Required) High School (DCPS) Howard University University of the District of Columbia (UDC) N/A DCPS High School Name(Required) DCPS Student ID(Required)Max. file size: 2 GB.GPA(Required)DCPA GPAHoward University Student ID(Required)Max. file size: 2 GB.GPA(Required)Howard GPAUniversity of the District of Columbia (UDC) Student ID(Required)Max. file size: 2 GB.GPA(Required)UDC GPAGovernment Issued ID(Required)Max. file size: 2 GB.Have you attended any other college?(Required) Yes No College Name(Required) College Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Attended From(Required) MM slash DD slash YYYY Attended To(Required) MM slash DD slash YYYY Major(Required) Did you earn a degree?(Required) Yes No Type of Degree(Required) GPA(Required)How did you learn about the PHIT4DC Grant Course?(Required) Community Presentation School (Howard, UDC, etc.) Website Employer Flyer Other Please Select Your Preferred Method of Learning(Required) In-Person Online Both Are you interested in taking the certification exam following completion of the course?(Required) Yes No Are you interested in receiving information about available support services and resources?Check all resources or services you are interested in receiving more information about. Transportation Housing Food Childcare Healthcare AcknowledgmentsConsent(Required) I understand that an offer of admission is conditional, pending receipt of final transcripts showing work comparable in quality to that upon which the offer was based.(Required)Consent(Required) I certify that all of the information submitted in the application is my own work, factually true, and honestly presented. I authorize all schools attended to release all requested records and authorize review of my application. I understand that I may be subject to a range of possible disciplinary actions, including admission revocation or expulsion, should the information I certified be false.(Required)Consent(Required) Your signature below is your confirmation that the application you have filled out is your own work and the information is factually true. Electronic signature consists simply of your name typed by you on your keyboard.(Required)Signature(Required)CAPTCHAHiddenUser IP(Required) CommentsThis field is for validation purposes and should be left unchanged.
