Professional Documents
Culture Documents
PR Profile Ofile: Biographic Informa Biographic Information Tion
PR Profile Ofile: Biographic Informa Biographic Information Tion
BIOGRAPHIC INFORMA
INFORMATION
TION
PR
PROFILE
OFILE
BIR
BIRTH
TH INFORMA
INFORMATION
TION
CONT
CONTA
ACT INFORMA
INFORMATION
TION
Address T
Type:
ype: Current Address T
Type:
ype: Permanent
Address: 11 igbasan street Opebi Ikeja Lagos Address: 11 igbasan street Opebi Ikeja Lagos
Ikeja, Lagos 234 Ikeja, Lagos 234
County: N/A County: N/A
Country: Nigeria Country: Nigeria
Valid Until Date:
Preferred Phone Number +2347035147623 Type: Mobile
CITIZENSHIP ST
STA
ATUS AND RESIDENCY INFORMA
INFORMATION
TION
CITIZENSHIP ST
STA
ATUS
RA
RACE/ETHNICITY
CE/ETHNICITY
Do yyou
ou consider yyourself
ourself to be of Hispanic/Latino origin? American Indian or Alaska Nativ
Nativee —
Answer: No Asian —
Black or African American Yes
Nativ
Nativee Ha
Hawaiian
waiian or other Pacific Islander —
Pacific
White —
BIOGRAPHIC INFORMA
INFORMATION
TION CONTINUED
FAMIL
AMILY
Y INFORMA
INFORMATION
TION
Guardian
OTHER INFORMA
INFORMATION
TION
Were yyou
ou honor
honorably
ably discharged from the military?
Answer: I did not serve
Ha
Havve yyou
ou been denied readmission?
Answer: No
Background Information
• I am from a family that lives in an area that is designated as a Health Professional Shortage Area or a Medically
Underserved Area.
What is yyour
our geogr
geographic
aphic area?
Answer: Mid-Size City(population 50,000 to 99,999 population)
Ha
Havve yyou
ou e
evver been disciplined for student conduct violations ((e.g.
e.g. academic probation, dismissal, suspension, disqualification, etc.) b
byy an
anyy college
or school?
Answer: No
Ha
Havve yyou
ou e
evver been disciplined for academic performance ((e.g.
e.g. academic probation, dismissal, suspension, disqualification, etc.) b
byy an
anyy college or
school?
Answer: No
Ha
Havve yyou
ou e
evver been con
convicted
victed of a F
Felon
elony?
y?
Answer: No
BIOGRAPHIC INFORMA
INFORMATION
TION CONTINUED
OTHER INFORMA
INFORMATION
TION
Ha
Havve yyou
ou e
evver had an
anyy certification, registr
registration,
ation, license or clinical privileges re
revvok
oked,
ed, suspended or in an
anyy wa
wayy restricted b
byy an institution, state or
locality?
Answer: No
Ha
Havve yyou
ou e
evver been con
convicted
victed of a Misdemeanor?
Answer: No
ACADEMIC HIST
HISTORY
ORY
ST
STAND
ANDARDIZED
ARDIZED TESTS
COLLEGES A
ATTENDED
TTENDED
444444 WOLEX POL
POLYTECHNIC
YTECHNIC
SUPPOR
SUPPORTING
TING INFORMA
INFORMATION
TION
DESIGNA
DESIGNATIONS
TIONS
MEDICAL LABORA
LABORAT
TORY SCIENCE
SUPPLEMENT
SUPPLEMENTAL
AL QUESTIONS
CLINICAL LABORA
LABORAT
TORY T
TOUR
OUR
* 1 In the last yyear
ear,, ha
havve yyou
ou visited and toured a hospital labor
laboratory?
atory?
Answer:
2 When did yyou
ou tour the labor
laboratory?
atory?
Answer:
3 Which hospital labor
laboratory
atory did yyou
ou tour?
Answer:
TRANSFER P
PA
ATHW
THWA
AY
1 Are yyou
ou participating in a tr
transfer
ansfer path
pathwa
wayy progr
program
am from one of our partner schools?
Answer:
RELEASE ST
STA
ATEMENT
I certify that I have read and will abide by all program-specific instructions
for my designated program.
I certify that all the information and statements I have provided in this
application are current, correct, and complete to the best of my knowledge.
I agree that the University of Tennessee Health Science Center may use this
information for educational research purposes (including surveys) aimed at
improving education and admissions programs.
Release Statement Answer: Check this box to indicate your understanding and acceptance of the terms described above.