Prospect Inquiry Form

Thank you for your interest in the University of Tennessee Health Science Center! Our goal is to form a unique partnership throughout the entire inquiry-to-admissions process. To begin that unique partnership, please complete the form below.

Please note that an asterisk denotes required information.

- indicates a required field.

Please enter a prefix [e.g., Ms., Mr., Mrs.]-if necessary, name, suffix [e.g., Sr., Jr., II]-if necessary, and nickname in mixed-upper and lower case format.

Prospect Name
Prefix:
First Name:
Middle Name:
Last Name:
Suffix:
Nickname:

Please enter your current mailing address using mixed-upper and lower case format [e.g., 910 Madison Ave].

Primary Address
Valid From:	Month Day Year (YYYY)
Until:	Month Day Year (YYYY)
Address Line 1:
Address Line 2:
Address Line 3:
City:
State or Province:
ZIP or Postal Code:
County:
Nation:
Phone Number:	- (xxxxxx)-(xxxxxxxxxxxx) (xxxxxxxxxx extension)
International Access Code:

Please enter your personal email address using mixed-upper and lower case format for both entries.

E-Mail Address
E-mail Address:
Verify E-mail Address:

Please select the entry term you expect to apply for admission to the University of Tennessee Health Science Center from the drop down menu .

Prospect Entry Term
Term of Entry:

Please select your gender from the options provided.

Prospect Gender
Gender:	Male	Female	Not Specified

Please select your birthdate month and day from the drop down menu. Also, enter your birthdate year [e.g., 1970].

Prospect Birthdate
Date of Birth:	Month Day Year (YYYY)

Please select your citizenship status from the drop down menu.

Prospect Citizenship
Citizenship:

Please select one major from the drop down menu.

Prospect Major
Major:

Please click on look up college code button and select your college code. Also, please complete the prior college section by using mixed-upper and lower case format and selecting from the drop down menus when necessary.

Prospect Prior College
College Code:
Prior College Name:
Address Line 1:
Address Line 2:
Address Line 3:
City:
State or Province:
ZIP or Postal Code:
Nation:
Attended From:
Attended To:
Graduation Date:	Month Day Year (YYYY)
GPA:	(example: 9.99)
Degree:

Please select How You Learned About UTHSC from the drop down menu. To select multiple options use Ctrl+Click for PC and Command+Click for Mac.

How Prospect Learned About Us
How I Learned About The University of Tennessee Health Science Center:

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