Pre-Health Registration Form
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Pre-Health Registration Form
Please fill out the information below to register as a pre-health student at Washington & Jefferson College. Items with a * are required, but it would help us greatly if you enter all information.
First Name
*
Middle Initial
Last Name
*
Student ID Number (from your student ID card - 7 digits)
*
W&J email address (please enter
FULL
W&J email address)
*
Permanent Home Address
Please enter permanent address information so the Committee on Health Professions has an up-to-date address to mail summer evaluations of students.
Street
City
State (use 2-letter abbreviation)
Zip Code
Academic Information
Please enter the following information about your career interests to the best of your ability.
Intended Major(s) (If you are completely unsure, it is ok (and required!) to type "Undecided" in the Major 1 box)
*
Enter at least 1 response and no more than 3 responses.
Major 1
Major 2
Major 3
Class
*
-- Please Select --
Freshman
Sophomore
Junior
Senior
Other
Primary Pre-Health Interest (Please select Undecided if you are completely unsure)
*
-- Please Select --
Allo
Chiro
Dent
Occupational Therapy
Opt
Osteo
Phy Therapy
Phy Assist.
Pod
Vet
Undecided
Other (specify below)
If you selected Other, please specify:
Secondary Pre-Health Interest
-- None --
Allo
Chiro
Dent
Occupational Therapy
Opt
Osteo
Phy Therapy
Phy Assist.
Pod
Vet
Undecided
Other (specify below)
If you selected Other, please specify:
Please double-check your information before clicking "Done" below.
Thank you!