UAB School of Public Health Information Request

Prospective Students - If you are a prospective student, and this is your first inquiry regarding graduate education at UAB SOPH, and would like to receive information and e-mail updates about graduate study opportunities, please complete the form below. Required fields are indicated with an (*) next to them.

First Name: *

Last Name: *

Middle Initial:

Are you an Alabama resident?: *

Yes

Are you an international student?: *

Yes

Country of Citizenship: *

E-mail Address: *

Address: *

City: *

Country: *

State: *

County: *

Zip Code:: *

Home Phone:: *

Date of Birth: *

Gender: *

Male

Female

Prefer not to answer

Anticipated Entry Term: *

Spring

Summer

Fall

Do you plan to pursue graduate study?: *

Full Time

Part Time

GRE Score:

MCAT Score:

GMAT Score:

LSAT Score:

DAT Score:

Undergraduate School Attended: *

Undergraduate GPA: *

Area of Study: *

Highest Degree Earned: *

Year Earned: *

Current Employer:

Please choose all departments of interest: *

Please tell us how you heard about us: *

Would you like to receive information on available scholarships?: *

Yes