La Salle University: Pre-Health Professions Program

For 3rd and 4th year students intending to apply to health professional schools at the end of this academic year
	* indicates required field
Name: (last, first) *
LSU ID# *
Current GPA *
Major(s) *
Minor(s)
E-mail *
Birthdate *	/ / 19
School Address *
School Phone *	- -
Home Address *
City *
State *
Zip *
Home Phone *	- -
Academic Advisor *
Answer the following questions only if you transferred into La Salle from another college or university:
From which school did you transfer in?
In what subject did you major at that school?
If you received a degree from that school, what degree was it? (BS, MA, AS)
What year did you receive that degree?
Date entered La Salle	/ /
Expected month and year of Graduation *	/
Careers to which you might aspire (check those of interest; this is NOT binding)	Allopathic medicine Osteopathic medicine Veterinary medicine Dentistry Optometry Podiatry other
Courses completed *	Calculus I Biology 210 General Chem I General Chem II Organic I Organic II Physics I Physics II
Comment box for information regarding courses completed: