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Individual Campus Tour

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Background Information

First Name*Required × Error: A field is missing data or special characters were used. Please correct.

Last Name*Required × Error: A field is missing data or special characters were used. Please correct.

Address*Required × Error: A field is missing data or special characters were used. Please correct.

City*Required × Error: A field is missing data or special characters were used. Please correct.

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Zip Code*Required × Error: A field is missing data or special characters were used. Please correct.

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Texas Resident Yes No × Error: A field is missing data or special characters were used. Please correct.

Email Address (you@someplace.com)*Required × Error: A field is missing data or special characters were used. Please correct.

Phone Number (123-456-7890)*Required × Error: A field is missing data or special characters were used. Please correct.

Occupation × Error: A field is missing data or special characters were used. Please correct.

Graduate Education

Do you currently hold a Graduate degree? Yes No × Error: A field is missing data or special characters were used. Please correct.

Please indicate the program(s) you're interested in Doctor of Philosophy in Applied Clinical Research
Doctor of Physical Therapy
Master of Clinical Nutrition - Coordinated Program
Master of Clinical Nutrition - Nutrition Science Online Program
Master of Physician Assistant Studies
Master of Prosthetics-Orthotics
Master of Science in Genetic Counseling
Master of Science in Health Informatics
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Have you scheduled an appointment with your program of interest? Yes No × Error: A field is missing data or special characters were used. Please correct.

What is your anticipated date of entry to the UT Southwestern School of Health Professions?

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How did you hear about UT Southwestern School of Health Professions? (Other) × Error: A field is missing data or special characters were used. Please correct.

Undergraduate Education: (please skip if not applicable)

Name of High School × Error: A field is missing data or special characters were used. Please correct.

Name of School (Bachelor's Degree) × Error: A field is missing data or special characters were used. Please correct.

Name of School (Master's Degree) × Error: A field is missing data or special characters were used. Please correct.

Name of School (Doctor's Degree) × Error: A field is missing data or special characters were used. Please correct.

Graduation Date × Error: A field is missing data or special characters were used. Please correct.

What is your major or area of study? × Error: A field is missing data or special characters were used. Please correct.

How important are the following factors for deciding on where to earn your graduate degree?

Location Not Important at All Somewhat Important n/a Important Extremely Important × Error: A field is missing data or special characters were used. Please correct.

Tuition & Costs Not Important at All Somewhat Important n/a Important Extremely Important × Error: A field is missing data or special characters were used. Please correct.

Availability of Financial Aid Not Important at All Somewhat Important n/a Important Extremely Important × Error: A field is missing data or special characters were used. Please correct.

Availability of Scholarships Not Important at All Somewhat Important n/a Important Extremely Important × Error: A field is missing data or special characters were used. Please correct.

Mission of the Program Not Important at All Somewhat Important n/a Important Extremely Important × Error: A field is missing data or special characters were used. Please correct.

Curriculum of the Program Not Important at All Somewhat Important n/a Important Extremely Important × Error: A field is missing data or special characters were used. Please correct.

Quality & Reputation of the University/ School Not Important at All Somewhat Important n/a Important Extremely Important × Error: A field is missing data or special characters were used. Please correct.

Direct accessibility to a contact person in program Not Important at All Somewhat Important n/a Important Extremely Important × Error: A field is missing data or special characters were used. Please correct.

Campus Life Not Important at All Somewhat Important n/a Important Extremely Important × Error: A field is missing data or special characters were used. Please correct.

Class Size Not Important at All Somewhat Important n/a Important Extremely Important × Error: A field is missing data or special characters were used. Please correct.

Internship/ Rotation Opportunities Not Important at All Somewhat Important n/a Important Extremely Important × Error: A field is missing data or special characters were used. Please correct.

Other Important Factors × Error: A field is missing data or special characters were used. Please correct.

About You (Optional)

In an attempt to improve our marketing and outreach efforts, we request you provide the optional information to assist our programs in meeting our student's needs. The information provided below will be solely used for those purposes.

Age

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Gender

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Ethnicity Origin (or race):

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*Required

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