Lincoln Memorial University
School of Allied Health Sciences
Veterinary Health Science Program
Application for Admission
Application for (circle one) entrance into the VHS Program:
Associate
Bachelor
Name
Last
First
Middle
Preferred Name
E-Mail
Suffix
(e.g. name@net.com)
Preferred Method of Contact
Permanent Mailing Address
Address Line 1
State
Address Line 2
City
Zip
Parish or County
Country (if not USA)
Day Telephone
Night Telephone
Cell Phone
Date of Birth
Age Today
Gender
Ethnicity / Race (Optional)- circle one
White
Black
Hispanic
Asian
Other_____________________
Place of Birth
City
Are you a U.S. citizen?
State
since
Immigration Status (if applicable)
Permanent Resident
Alien Registration Number
VISA Type
Phone
State of Legal Residence
Country (if not USA)
If no, what is the country of your citizenship?
U.S. State of Residence
Parent/Guardian
Father is
living
Name
Address
Parish or County of Birth
Refugee
deceased
Non-Immigrant
issued in
Mother is
Name
Address
living
on
deceased
Phone
State of Legal Residence
No student may be admitted as a Tennessee resident unless all residence requirements are fulfilled and verified by the Office of the Registrar,
Lincoln Memorial University.
High School and Colleges Attended/Dates of Attendance
Name
From
To
Name
From
To
Name
From
To
Name
From
To
Animal Experience
1.
Experience
City
Reference
Reference’s Telephone Number
Dates From
To
Total Hours
State
Volunteered
Paid
Description of Responsibilities:
2.
Experience
City
Reference
Reference’s Telephone Number
Dates From
To
Total Hours
State
Volunteered
Paid
Description of Responsibilities:
Other Employment Experience
1.
Type of experience
City
Reference
Reference’s Telephone Number
Dates From
Description of Duties
To
Total Hours
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State
2.
Type of experience
City
Reference
Reference’s Telephone Number
Dates From
Description of Duties
To
State
Total Hours
3.
Type of Experience
City
Reference
Reference’s Telephone Number
Dates From
Description of Duties
To
State
Total Hours
Extracurricular and Community Activities (list the three you consider the most significant)
Type of Activity
Description of Activity
Dates From
To
Type of Activity
Description of Activity
Dates From
To
Type of Activity
Description of Activity
Dates From
To
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Honors and Awards (list the three you consider the most significant)
Honor/Award
Description of Honor/Award
Date Received
Honor/Award
Description of Honor/Award
Date Received
Honor/Award
Description of Honor/Award
Date Received
Personal Statement (attach to application)
Your personal statement should include but not be limited to your career in veterinary medicine. You should also address what you consider
your strongest character trait and how this trait has helped you and will continue to help you succeed while in college. The length of your
personal statement should be at least one-half page but will be limited to no more than one single spaced page.
Confidential Evaluators (please list the names of the individuals who will submit evaluations on your behalf)
Academic recommendation
Veterinarian or credentialed technician recommendation
Were you ever the recipient of any action (e.g. dismissal, disqualification, suspension, etc.) by any school
for unacceptable academic performance or conduct violations?
Yes
No
If yes, provide a brief explanation.
Have you ever pled nolo contendere (no contest) or been convicted of either a felony or a misdemeanor,
other than a minor traffic violation?
Yes
No
If yes, provide a brief explanation.
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Signature
With your signature, you verify that the information contained in this application is complete and accurate.
Date of Submission
At LMU, there is a rolling admissions policy. The LMU VHS program also observes a rolling
admissions policy. In order to be considered for admissions to the VHS program, you will want to send
your application in as early as possible.
FINAL ACCEPTANCE OF ADMISSION INTO THE VETERINARY HEALTH SCIENCE PROGRAM IS
CONTINGENT UPON ACCEPTANCE TO LINCOLN MEMORIAL UNIVERSITY.
You may hand deliver your application or it may be delivered via mail to:
Veterinary Health Science Program
Lincoln Memorial University
Schenck Center for Health Sciences
6965 Cumberland Gap Parkway
Harrogate, TN 37752
For Departmental Use Only:
Date Received: __________
Accept/Deny: ___________
VHS Admissions Personnel: __________________
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