Student Name: _____________________________________________ ID #: __________________
Major #1: _____________________________ Major #2: __________________________________
Minor #1: _____________________________ Minor #2: __________________________________
I formally declare that I am pursuing the following pre-professional health program and/or 3-2 program. Please check appropriate
box:
□ 3-2 Programs (Atmospheric Science and/or Engineering)
□ Pre-professional Health Careers
□ Dentistry
□ Medicine
□ Nursing
□ Occupational Therapy
□ Optometry
□ Pharmacy
□ Physical Therapy
□ Physician Assistant
□ Veterinary Medicine
□ Other ___________________________
Expected Graduation Date: ___________________________
The formal declaration will allow me, if necessary, to take an academic course load of 5.0 course credits without having to submit a
formal petition for an overload to the Admission and Academic Status Committee. I must, however, have both my advisor and pre-
professional advisor approval (if different), to register for 5.0 academic course credits.
I also understand that if I am no longer pursuing a pre-professional or 3-2 program, that I am required to notify the Office of the
Registrar.
Signature of Student: ______________________________________ Date: ____________________
Signature of Advisor: _______________________________________ Date: ____________________
Signature of Pre-professional Advisor: ____________________________________ Date: __________
3-2 Engineering and 3-2 Atmospheric Science: Dr. Chris Fasano
Pre-professional Health Careers: Dr. Laura Moore or Dr. Kevin Baldwin
Pre- Occupational Therapy: Dr. Marsha Dopheide
02/17
Declaration of
Pre-Professional Health Program/
3-2 program
