College of Pharmacy and Health Sciences

Interest Form

Fields marked with an asterisk (*) are required fields.

First name *

Middle name

Last name *

Date of birth

Email address *

Phone

Mailing address

Country

Street

City

Region

Postal Code

Student Type:

Parent/guardian first name

Parent/guardian last name

Parent/guardian email

Parent/guardian phone number

Expected program entry term

Program of interest *

Current (or most recent) school *