Request for Information

* indicates a required field

Student Biographical Information

Student Given First Name

Student Preferred First Name (if different)

If a preferred name is provided, we will use it in all communications including physical mailings to your mailing address.

Student Last Name

Birthdate

Student Contact Information

Student Email Address

Please note that there is an opportunity at the bottom of this form to provide a parent/guardian email address for communication purposes. The "Student Email Address" should be unique to this student.

Student Mobile Phone Number

By providing your mobile phone number, you agree to receive text messages from Elizabethtown College.

Student Mailing Address

Country

Street

City

Region

Postal Code

Student Academic Information

Intended Entry Term

Student Type

Primary Academic Interest

Secondary Academic Interest (if applicable)

Occupational Therapy is a 5-year BS/MS or 6-year BS/OTD degree program. The completed application and a required interview are due by December 15th of the year prior to your Entry Term (typically your senior year).

An audition is required for all music majors.

Begin typing the name of your school and select it from the dropdown.

Current (or most recent) School

I am homeschooled.

I have my GED.

I cannot find my school in the dropdown.

Additional Contact Information

Would you like to provide us with a parent, guardian, or other individual's contact information so that we can send them information too?

Yes

Additional Contact's First Name

Additional Contact's Last Name

Additional Contact's Relation to Student

Additional Contact's Email Address

Additional Contact's Phone Number