UT Memphis
Information/Application Request Form

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Country County (if US)
SS# Telephone#

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Educational Information

College attended/now attending:
Graduation Year GPA

Test Score Data (please select only one)

DAT
GRE
MCAT
PCAT
TOEFL
Score

Area of Interest (please select only one)

College of Allied Health Sciences

Clinical Laboratory Sciences M.S.
Part-Time Full-Time
Area of Concentration
Laboratory Management
Laboratory Utilization
Cytotechnology
Dental Hygiene
Health Information Management
Medical Technology
Occupational Therapy
Physical Therapy Entry Level M.P.T.
Physical Therapy M.S.
Part-Time Full-Time
Area of Concentration
Musculoskeletal Sciences
Neurological Sciences
Adult
Pediatrics

College of Dentistry

Dentistry
Dentistry - Advanced Standing

Graduate Health Sciences

Anatomy and Neurobiology
Biochemistry
Biomedical Engineering M.S.
Biomedical Engineering Ph.D.
Dental Science (M.S.) (check one concentration area)
Concentration in Orthodontics
Concentration in Pediatric Dentistry
Concentration in Periodontics
Epidemiology (M.S.)
Health Science Administration
Microbiology and Immunology
Nursing (Ph.D.)
Pathology
Pharmaceutical Sciences (check one concentration area)
Concentration in Medicinal Chemistry
Concentration in Pharmaceutics
Pharmacology
Physiology

College of Medicine

Medicine - Advanced Standing

College of Nursing

Nursing - MSN
Area of Concentration
Acute Critical Care Nurse Practitioner
Family Nurse Practitioner
Medical/Surgical Nurse Practitioner
Neonatal Nurse Practitioner
Nurse Anesthesia (Medical Center at Knoxville)
CRNA-MSN
Psychiatric Family Nurse Practitioner

Nursing - DNSc
Area of Concentration
Acute Critical Care Nurse Practitioner
Family Nurse Practitioner
Medical/Surgical Nurse Practitioner
Neonatal Nurse Practitioner
Nurse Anesthesia (Medical Center at Knoxville)
CRNA-DNSc
Psychiatric Family Nurse Practitioner
Public/Community Health Nursing Administration*
Nursing Administration
Midwifery**

College of Pharmacy

PharmD
PharmD - Advanced Standing

 

I plan to enroll:

Fall
Spring

Year:

Please send the following:

Application
General Information
Financial Aid Information
Housing Information

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