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Personal Information
 Physical Address

* Rollins School of Public Health will use this address to mail you any relevant billing paperwork

Contact Information

Primary Affiliations

Note: You may receive the error message below after submitting this form. Here's why:
Error message : 
1. Update - Lookup returned no record and aborted connector execution Solution:  We cannot find your Hiring Department ID. Please check your entries for Hiring Department ID. If you cannot resolve this issue, please email sphsfprod@emory.edu.  

Note: Please enter or select Your Affiliation Organization. If not found, please add your organization.
Steps to finding your Department ID: Go to -> https://hr.emory.edu/eu/index.html | Select -> Self-Service Log In | Select -> Payroll | Under Paychecks -> Select any past paycheck | Locate “Department:” Enter this number including all leading zeros into this field
Steps to finding your Employee ID: Go to -> https://hr.emory.edu/eu/index.html | Select -> Self-Service Log In | Select -> Payroll | Under Paychecks -> Select any past paycheck | Locate “Employee ID:” Enter this number including all leading zeros into this field

* I am a designated signatory authorized to sign the Memorandum of Understanding (MOU) agreement on behalf of my organization.

Additional Information
Communication Preferences

Attachment

* We review the mission of your organization, a draft job description aligned with public health competencies, financial statement for cost-sharing potential and then send you an MOU for signature. Please attach the following documents for your required application.

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