Christopher Newport University | Biology, Chemistry and Environmental Science

HPAC:

Health Profession Intent Form


CNU students: Register your interest or intent to pursue a Health Profession in three easy steps.

1.	Complete the following information to register your interest in a Health Profession.	2.	Update your information as often as necessary to remain current and maintain your status.	3.	To add updates after your original submission: Key in your name, CNU student ID# and email, then any updates.

*Fields marked with indicate required information.**

*First Name:	*Last Name:
*Email Account(s):	*CNU Student ID:
Local Phone: (757) -	Cell Phone: ( ) -
Residence Hall:	MailBox Number:
OR
Local Address:	City, State, Zip:

Semester Entering CNU:	Year:
Major:	Semester Hours Completed: (Please keep current each semester.)
Minor:
Check all that apply: Honors Biology Degree w/ Distinction President's Leadership Program Beta Beta Beta Other:
Prehealth Area of Interest:
Pre-Med Pre-Dental Pre-Pharmacy	Physician's Assistant Physical Therapy Pre-Vet Other:

Permanent Home Address:
City: State: Zipcode:

Additional Comments/Information: