Register Now – Marshall University Medical HELP Program

Medical HELP Registration

Name

First Last

Phone

Current Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Permanent Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Which Medical HELP course are you interested in?

Have you ever taken a standardized assessment specific to your field?(Required)

Yes

For example: MCAT, NCLEX, OAT, DAT, PCAT, etc.

If so, how many times have you taken the exam(s)?

Provide scores and approximate date(s).

Where do you (or did you) attend professional school?

What other professional schools have you attended (if any)?

List reasons for leaving

If you're still attending professional school, what is your current status (be as specific as possible)?

List your most difficult courses and note those you have failed or have had a marginal pass

Have you ever completed diagnostic testing?

Yes

Unsure

Name and agency of professional who conducted the evaluation

Date of Evaluation

Conclusions or notable findings

How did you find out about the Medical H.E.L.P. Program?

Name of referral

First Last

Profession

Phone

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