Dental Hygiene Virtual Academic Department Visit

Prospective Student Information

Student First Name*

Do you have a preferred first name (different from your legal name) that you would like to provide us?*
Note: UofL uses preferred name in communications to you via text, email and in print mailed to your address. We also use it when communicating with parents/guardians. If you are not comfortable having some people know this first name, you do not need to share it at this time.

Yes

No

Student Preferred Name

Student Last Name*

Student Birthdate*

Mailing Address

Country

Street

City

Region

Postal Code

Personal Email Address*

Mobile Phone*

Would you like to receive text communications/reminders about your upcoming visit (carrier data rates may apply)?

*

Yes

No

Academic Information

Current school level of study*

College Level

High School Level (only report school you are graduating from)

Current School*
Please type your school name, then scroll and SELECT your school from the drop down to ensure a match with our records. Typing in a city or abbreviated state (ex: Sacred Heart KY) can also help narrow your search.

Intended Major*

Expected Graduation Date*