Application for Post-Baccalaureate
Pre-Health Professions Program

Upon submission a $25 payment by credit card is required.

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Personal Information
First name	Last name
Social Security Number - -	Date of birth (mm/dd/yyyy) / /
Street address	City
State	Postal/Zip Code
Primary phone - -	Secondary phone - -
Email address
Have you previously applied to Manchester University? Yes No
Please list in chronological order all colleges and graduate schools attended. Transcripts must be requested from all schools attended, whether or not a degree was received.
School #1
Name	Location
Dates	Degree
Major/minor
School #2
Name	Location
Dates	Degree
Major/minor
School #3
Name	Location
Dates	Degree
Major/minor
School #4
Name	Location
Dates	Degree
Major/minor
Reference Information
Reference #1
First name	Last name
Email address	Phone - -
Reference #2
First name	Last name
Email address	Phone - -
Optional: for statistical, planning and administrative purposes. This will not affect your eligibility to our program.
Gender Female Male	Ethnicity African American/Black Multi-racial Hispanic/Latino Caucasian/White Asian/Pacific Islander Native American Other:
Statement of Intent:
Include information on why you want to work in the health care field, and how our program can help you achieve that goal. Please upload your statement of intent as a "pdf" or "Microsoft Word" file.