First Advising Appointment Date _______________
Pre-Health Professions Advising:
New Advisee Registration Form
Name ___________________________________________
Place Photo Here
Box Number ___________________Ext. ______________
Class of ___________ Messiah E-mail ________________
Address and Telephone Number where you can be reached
during vacation periods. (Usually your home address)
Address ________________________________________
________________________________________________
________________________________________________
Telephone _____________________ Cell _____________
State of Legal Residence ____________________________
Citizenship ____________________ Other Language Spoken _____________________
Social Security Number ______________________________
Area(s) of Medical Interest: (Check all that apply)
Allopathic Medicine (MD)

Osteopathic Medicine (DO)

Dentistry

Veterinary Medicine

Physician Assistant

Chiropractic Medicine







Occupational Therapy
Optometry
Pharmacy
Physical Therapy
Podiatry
Other:_______________
Academic Major/Minor _____________________ Are you in the Pre-Med Program?  Yes  No
Advisor ___________________________________ Ext.________________________________
Overall Messiah GPA (if applicable) _____________ Messiah Science GPA __________ (BCPM)
(To calculate your Messiah GPA, multiply the grade equivalent for each course taken at Messiah (A = 4.0; A- = 3.67; B+ = 3.33,
etc.) by the number of credits for that course, sum these numbers and divide by the total number of credits.)
Relevant Coursework:
Course Name and Number
BIOL 160 – BIO I
BIOL 161 – BIO II
BIOL 162 – BIO III
BIOL 281 – Genetics
BIOL 385 – Physiology
BIOL 386 – Human Anatomy
Grade
Semester/Year
Other Biology
Course Name and Number
CHEM 105 – Gen Chem I
CHEM 106 – Gen Chem II
CHEM 309 – Organic I
CHEM 310 – Organic II
CHEM 410 – Biochem
CHEM 411 – Biochem Lab
Other Chemistry
Grade
Semester/Year
PHYS 201 or 211
PHYS 202 or 212
MATH 108 or 111
Other Computer/Math/Statistics
English Courses(s)
FYS
Writing Intensive Course
Other English Courses
SAT Scores _______________________________AP Credits and Scores ________________
Messiah Scholarships/Programs (check those that apply).
 Emerging Leaders

Provost’s
Scholarship


 Multicultural

 Other:________________________
Dean’s Scholarship
Honors Program
President’s Scholarship
Messiah Co-Curricular Activities:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Describe any experiences that you have had in the health sciences that have been important to you
(summer employment, research projects, missions trips, internships, etc.).
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Significant High School Honors/Accomplishments/Experiences:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Updated 09-10