PREMED Interest
Questionnaire
To make sure our files are accurate; please take a moment
to complete this.
Date __________________________________
First Name ___________________________________
Last Name ____________________________________
Still interested in a being a member of the Premedical Sciences Society?
o No, please remove me from your database and e-mail list.
o Yes, see my current information below.
IC E-mail _____________________________
Expected Graduation ____________________
(semester and term)
Major _________________________________
Advisor ________________________________
Has your particular interests in health profession changed since you became a member of the
Premedical Sciences Science?
If so, what is your current interest?
Return this form to the Biology Department, CNS 161.
9/2011