Campus Selection Form

Campus Information | Campus Selection Process | Campus Selection Form | Living in Wichita

Class of 2016 - This form must be submitted by November 19, 2012 before 5:00 pm.

Students who have not submitted a request by November 19, 2012, will be considered as a student who has no preference and will be assigned to the campus that has not reached its required number of students.

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First Name
Last Name
E-mail

I request to be considered for assignment to the clinical campus checked below:
	Kansas City
	Wichita
	Either campus

I feel I should be given special consideration for the campus I have chosen based on the hardship reason listed below. Explain in detail.

Last modified: Nov 16, 2012

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Campus Selection Form