Allied Health Request for Information

Student Information

First Name*

Preferred Name

Last Name*

Birthdate*

Email Address*

Mailing Address

Country

Street

City

Region

Postal Code

Student Type*

First-Year Student

Transfer

Adult

Special - seeking Certificate

First-Year Student - You are considered a first-year student if you are currently in high school and plan to enroll at UA after graduation or you’ve been out of high school for less than two years.

Transfer - You are considered a transfer student if you have enrolled at another college or university since graduating from high school. (Does not include CCP coursework.)

Adult Student - You are considered an adult student if you’ve never attended college and it’s been more than two years since you graduated from high school or earned a G.E.D.

Special - You are considered a special student if you are seeking a stand alone certificate program

Note: Students who are in high school taking CCP courses would be considered First-Year Student.

Parent Information - Optional

Relationship Type

Parent First Name

Parent Last Name

Parent Email

Academic Information

Anticipated Start Term*

Major of Interest

Certificate of Interest

Current High School*

High School Graduation Year*

Most Recent Transfer Institution