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Marshall University Medical HELP Program

Register Now

Medical HELP Registration

General Informatoin

Name

First Last

Email

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

This field is hidden when viewing the form

Which Medical HELP course are you interested in?

Which Medical HELP course are you interested in?

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

Yes

No

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).

Professional School

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

Diagnostic Testing

Have you ever completed diagnostic testing?

Yes

No

Unsure

Name and agency of professional who conducted the evaluation

Date of Evaluation

Conclusions or notable findings

Referral

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

Name of referral

First Last

Profession

Email

Phone

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