Environment & Public Health Risk Free Application 

Fill in the form below to be considered for the Environment & Public Health program before submitting the $40 application fee. Please be sure to upload your electronic unofficial undergraduate transcript (PDF or Word Doc ONLY) with the form so we can determine if you qualify for the course. We will notify you about your eligibility after your application and transcripts have been received and reviewed.

NOTE: If you do not have an electronic copy of your transcript, please mail or fax it to us instead.
Mail to: Office of Continuing Professional Education, 102 Ryders Lane, New Brunswick, NJ 08901-8519
Fax to: 732-932-1187
Either should be marked: "Attention Becky or Marianne"

* Items marked with an asterisk (*) are required fields.

---

First name*
Last name*
Job Title
Company
Street Address
City
State / Province
Zip / Postal code
Country
Phone Number*
Fax Number
E-mail Address*
Please contact my by	Email Fax Mail
How did you hear about us
Additional Comments
Attach your transcript (PDF or DOC files)
May we add you to our mailing list? * (You will receive periodic updates.)	(Choose One) Yes, email me Yes, fax me Both formmail

---

Questions?
Phone: 732-932-9271
Email: eph@njaes.rutgers.edu
Ask for Becky or Marianne