Clinical Campus Selection Form

Class of 2011 - This form must be submitted by November 26, 2007.

Students who have not submitted a request by November 26, 2007, 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.

Request More Information

Academic and Student Affairs > Campus Selection Process > Campus Selection Form

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