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Request for a Major in Health Administration

STUDENT NAME
STUDENT ID#
Local ADDRESS
CITY
STATE / ZIP
Zip code:
TELEPHONE
Home ADDRESS
CITY
STATE / ZIP
Zip code:
TELEPHONE
E-MAIL
Expected Graduation Date
Please mark the box of the major or minor for which you need an advisor.
Complete this section ONLY if you have been PREVIOUSLY
assigned an advisor in THIS department.
Does the above NEW request replace or supersede a previous
request or assignment? YES NO
Who was your previous advisor?
Major or Minor?