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Contact Information
Demographic Information
Address
Parent Information
Academic & Education Information
Acknowledgements
Required
is required
is Required
First Name
Required
Middle Name
Required
Last Name
Required
Former Name
Required
Email Address
Required
is Required
Home Phone
Required
Home Phone Area Code
Home Phone Exchange
Home Phone Number
Home Phone Extension
Ext:
Mobile Phone
Required
Mobile Phone Area Code
Mobile Phone Exchange
Mobile Phone Number
Mobile Phone Extension
Ext:
is Required
is Required
is Required
Today's Date (mm/dd/yyyy)
Required
Signature (Please type your full name)
Required
How did you hear about our program?
Required
-- select one --
Academic Institution
Career Fair
Former Student
Friend/Relative/Co-Worker
Internet
Social Media
Other
Are you 18 years of age or older?
Required
-- select one --
Yes
No
Are you able to attend this program without visa sponsorship?
Required
-- select one --
Yes
No
Are you proficient in English?
Required
-- select one --
Yes, my primary language is English
Yes, and I have completed the DET and earned the required minimum score
Yes, and I have completed the TOEFL and earned the required minimum scores
No
I certify that all information submitted in the admission process, including this application and any other supporting materials, is my own work, factually true, and honestly presented, and that these documents will become the property of the School of Health Professions and will not be returned to me. I am aware I must meet health and background check requirements in order to begin my program. I understand that I may be subject to a range of possible disciplinary actions, including admission revocation, expulsion, or revocation of course credit, grades, and certificate should the information I have provided be false. I agree to notify the School of Health Professions immediately should there be any change to my criminal history or the information requested in this application.