Rural PharmD Virtual Information Session

Personal Information

First (Given) Name*

Last (Family) Name*

Email Address*

Confirm Email Address*

Mobile Phone*

Birthdate

Expected Entry Term

I am a

Current College Student

Current High School Student

What college do you currently attend?

What high school do you currently attend?

Optional Demographics

To help us get a better understanding of our recruitment efforts so that we ensure a diverse applicant pool and diverse student body within the College of Pharmacy, we make an effort to collect ethnicity/race information. Providing this information is optional.

I consent to having this information collected.

Yes

No

Are you Hispanic or Latino?

Yes

No

Please select any ethnic group to which you identify.

Check Yes if you consent to receiving communications via text message.

Yes