FDU Strong Application

Student Information

Your Degree Program

Major Minor

Expected Graduation Date

Graduation Date

Demographic Information

Citizenship Status*

US Citizen
Permanent Resident or National
Not a Citizen, Permanent Resident, or National

Are You a US Veteran or Reservist*

Yes, Veteran Reservist, or National Guard
No

Biologic Sex at Birth*

Male
Female

Do you consider yourself to be of Hispanic or Latino Descent?*

Yes, Hispanic or Latino
No, Neither

Which one of the following categories best describes you?*

White

Background

Do you believe that you have ever lived in a Medically Underserved Area?*
The U.S. Health Services Administration (HRSA) defines medically underserved areas as areas lacking access to primary care services.

Do you believe that you are from an Environmentally Disadvantaged background?*
The U.S. Health Services Administration (HRSA) defines this as a person whose environment inhibited them from obtaining the knowledge, skills, and abilities required to enroll in and graduate from a health professions school.

Do you believe that you are from an Economically Disadvantaged background?*
The U.S. Health Services Administration (HRSA) defines this as a person from a family with an annual income below a level based on low-income thresholds, according to family size established by the U.S. Census Bureau. A family is a group of two or more people.*

Do you believe that you are from an Educationally Disadvantaged background?*
The U.S. Health Services Administration (HRSA) defines this as a person from a social, cultural, or educational environment that has demonstrably and directly inhibited the person from obtaining the knowledge, skills, and abilities necessary to develop and participate in a health professions education or training program.*

Yes
No

Personal Statement

Submit a statement of interest to be considered for acceptance into the FDU STRONG Opioid Impacted Family Support Specialist Certificate Program. Your statement should describe how your background, interests, and lived experiences have motivated you to pursue this opportunity to advance your career in healthcare services, specifically working with populations affected by Opioid Use Disorder (OUD) and Substance Use Disorder (SUD).*
This statement should be no less than 250 words.

Word count: 0

Student Endorsement