Survey | Prematriculation Program

First Name

Last Name

Email Address

Wright State University Email Address (e.g. smith101@wright.edu)

Mobile Phone Number (123-457-7890)

Mailing Address

City

Zip Code

Mailing Address - Local
(leave blank if the address is pending)

City, State - Local
(leave blank if the address is pending)

Zip Code - Local
(leave blank if the address is pending)

Which of the following best describes your current status?

Not yet applied.
Applied, but awaiting decision.
Currently on the "wait" list.
Committed to enroll.

Prematriculation Program participants who meet the qualifications listed below are given preference in the selection process, please check all that apply:

Student was a non-science undergraduate major

Student is non-traditional or changing professions

Student has been out of school for a substantial period

Student has educational background that puts them at a disadvantage

Student is a member of a group under-represented in medicine

Other

Are you interested in temporary on campus housing while participating in the program?

Yes, I am in interested in on campus temporary housing.
Maybe
No, I have organized my own local housing.