Register with the Premedical Programs for 2010-2011 Survey

Welcome to the 2010-2011 academic year at University of Dayton! Please provide the following information so that we can provide you with up to date information and resources of the Premdical Programs Office.

1. Please complete the following sections.

	MM		DD		YYYY
Today's Date	Please complete the following sections. Today's Date Month	/	Day	/	Year

2. Demographic Information:

Demographic Information: Last Name
First Name
Middle Name
Full Name (with middle initial) Ex. John J. Smith

3. Current Status:

Current Status: First Year

Second Year

Third Year

Fourth Year

Fifth Year

4. Please provide your 2010-2011 CAMPUS ADDRESS.

NOTE: If you are in campus housing:
* Enter your 4 digit zip in the space provided.
* Leave City and State spaces BLANK.

Please provide your 2010-2011 CAMPUS ADDRESS. NOTE: If you are in campus housing: * Enter your 4 digit zip in the space provided. * Leave City and State spaces BLANK. Address:
City/Town:
State:
ZIP:
Email Address:
Phone Number:

*
5. Please provide your PERMANENT ADDRESS and phone.

Please provide your PERMANENT ADDRESS and phone. Address:
Address 2:
City/Town:
State:
ZIP:
Email Address:
Phone Number:

6. What is your current MAJOR?

What is your current MAJOR? MED (Premedicine)

DEN (Predentistry)

BIO (Biology)

Other (please specify)

*
7. Who is your current advisor?

Who is your current advisor?

8. Who is your MED/DEN advisor? (Will be the same as academic advisor for MED/DEN majors.)

Who is your MED/DEN advisor? (Will be the same as academic advisor for MED/DEN majors.) Atif A. Abueida, Ph.D.

Mohamed Ahoujja, Ph.D.

Albert J. Burky, Ph.D.

Bruce A. Craver, Ph.D.

Kevin Church, Ph.D.

Carl F. Friese, Ph.D.

Karolyn Hansen, Ph.D.

David W. Johnson, Ph.D.

Madhuri Kango-Singh, Ph.D.

Robert J. Kearns, Ph.D.

Carissa M. Krane, Ph.D.

Matthew E. Lopper, Ph.D.

Mark G. Nielsen, Ph.D.

John J. Rowe, Ph.D.

Kathleen C. Scheltens, Ph.D.

Todd B. Smith, Ph.D.

Amit Singh, Ph.D.

Shawn M. Swavey, Ph.D.

Thomas M. Williams, Ph.D.

Shirley A. Wright, Ph.D.

9. Anticipated Graduation Year

Anticipated Graduation Year 2012

2013

2014

2015

10. Which of the following resources would you find helpful for receiving information from the Premedical Programs Office?

	Definitely Valuable	Somewhat Valuable	Not Valuable
Email	*Which of the following resources would you find helpful for receiving information from the Premedical Programs Office? Email Definitely Valuable	Email Somewhat Valuable	Email Not Valuable
Mailed Copy of Newsletter	Mailed Copy of Newsletter Definitely Valuable	Mailed Copy of Newsletter Somewhat Valuable	Mailed Copy of Newsletter Not Valuable
Facebook	Facebook Definitely Valuable	Facebook Somewhat Valuable	Facebook Not Valuable
Twitter	Twitter Definitely Valuable	Twitter Somewhat Valuable	Twitter Not Valuable
Premed Programs Website	Premed Programs Website Definitely Valuable	Premed Programs Website Somewhat Valuable	Premed Programs Website Not Valuable

Other (please specify)

Register with the Premedical Programs for 2010-2011
Exit this survey

1. Welcome!

1. Please complete the following sections.

2. Demographic Information:

3. Current Status:

4. Please provide your 2010-2011 CAMPUS ADDRESS.

NOTE: If you are in campus housing:
* Enter your 4 digit zip in the space provided.
* Leave City and State spaces BLANK.

*
5. Please provide your PERMANENT ADDRESS and phone.

6. What is your current MAJOR?

*
7. Who is your current advisor?

8. Who is your MED/DEN advisor? (Will be the same as academic advisor for MED/DEN majors.)

9. Anticipated Graduation Year

10. Which of the following resources would you find helpful for receiving information from the Premedical Programs Office?

Register with the Premedical Programs for 2010-2011Exit this survey

1. Welcome!

1. Please complete the following sections.

2. Demographic Information:

3. Current Status:

4. Please provide your 2010-2011 CAMPUS ADDRESS. NOTE: If you are in campus housing:* Enter your 4 digit zip in the space provided.* Leave City and State spaces BLANK.

*5. Please provide your PERMANENT ADDRESS and phone.

6. What is your current MAJOR?

*7. Who is your current advisor?

8. Who is your MED/DEN advisor? (Will be the same as academic advisor for MED/DEN majors.)

9. Anticipated Graduation Year

10. Which of the following resources would you find helpful for receiving information from the Premedical Programs Office?

Register with the Premedical Programs for 2010-2011
Exit this survey

4. Please provide your 2010-2011 CAMPUS ADDRESS.

NOTE: If you are in campus housing:
* Enter your 4 digit zip in the space provided.
* Leave City and State spaces BLANK.

*
5. Please provide your PERMANENT ADDRESS and phone.

*
7. Who is your current advisor?