Public Health Professional Services Consultant Enrollment Be part of the solutions that Ohio Public Health Association can offer to our membership. Name* First Last Email* Phone*Address* Street Address City State / Province / Region Zip Code / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Please Upload Resume or Curriculum Vitae Here*Accepted file types: jpg, pdf, png, doc, docx, xls, xlsx, ppt, Max. file size: 256 MB.Allowed extensions: jpg,pdf,png,doc,docx,xls,xlsx,pptMaximum number of hours available per week* 0-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 How quickly can you begin to work from contact time* 0-3 days 4-6 days 1 week 2 weeks 3-4 weeks > 1 month Please provide your general availability* Business Hours Evenings Weekends Mornings Afternoons Check all that applyPlease provide your academic degrees licenses* Associates Bachelor's Master's Master of Public Health Master of Business Administration Master of Public Administration Master of Nursing Doctorate Doctorate in Public Health Other None Check all that applyIf Other, PAcademic Degrees Licenses please specify Please provide your professional licenses* Registered Nurse Advanced Practice Nurse (NP, CNM, CNL, CNS) Registered Sanitatarian Registered Dietician Licensed Social Worker Physician (MD, DO) Pharmacist Dentist Other None Check all that applyIf Other, Professional Licenses please specify Are you qualified to administer vaccines?* Yes No Please select your professional certifications* Certified Health Education Specialist (CHES, MCHES) Certification in Public Health (CPH) Other None If Other, Professional Certification please specify Please select your professional specialities* Epidemiology Health Education Clinical patient care Biostatistics Environmental Health REHS Finance/Accounting Grant management Clerical/administration Vital statistics/registrar Leadership/management Communications/public information specialist Accreditation Public Health Nursing Registered Dietitian Emergency Management Other Check all that applyIf Other, Professional Specialities please specify General Comments or Questions