Fillable Advisee Information Sheet First Middle Last (South Plains College)

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Advisee Information Sheet First Middle Last (South Plains College)

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If at any
time you have a question, please contact the PTA program office 806.716.2470 or 806.716.2518
Advisee Information Sheet
Student Name____________________________________________ _______DOB _________________
First Middle Last
Address
______________________________________________________________________________
Phone #_
_______________________________ Alternate Phone #_______________________________
Preferred Email________________________________________________________________________
SPC Em
ail _____________________________________________________________________________
Emergenc
y Contact_____________________________ Phone # _________________________________
Demographic Information: Do you already have a degree? Y [ ] N [ ] What? ______________
Have you applied to PT school before? Y [ ] N [ ]
Do you have an active application for PT School or another Allied Health Program? Y [ ] N [ ]
I acknowledge that my advisor has reviewed the Program application information with me and I have been
provided a written copy of the Admission Information Sheet.
Applicant
’s Signature____________________________________________________
modified Jan 2019
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Advisee Information Sheet First Middle Last (South Plains College)

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Completed 7 October 2020

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