The Herbert H. and Grace A. Dow College of Health Professions School of Health Sciences
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UNDERGRADUATE ADVISOR REQUEST

(Office Use Only) Assigned To _____________ Notified _______
 DATE   11/22/2009 3:32:45 AM
 STUDENT
 NAME		  
 LOCAL
 ADDRESS		  
 CITY  
 STATE.ZIP    Zip code:
 TELEPHONE  
 HOME
 ADDRESS		  
 CITY  
 STATE.ZIP    Zip code:
 TELEPHONE  
 E-MAIL  
Please mark the box of the major or minor for which you need an advisor.
Note: School of Health major cannot have a minor in the School of Health Sciences unless it is a second minor.

** School of Health majors and minors must be on a teaching program. Please indicate if it is elementary or secondary.
   Major  Minor
 Public Health      
 Health Fitness*      
 Exercise Science      
 Allied Health      
 School Health**    Elem Second  
 Substance Abuse       
 Health
 Administration		      
 Personal &
 Community Health		        
 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?


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