Undergraduate Application

The application and all pertinent forms should be on file with the Undergraduate Studies office at least four weeks prior to the beginning of the desired starting academic term. Students are encouraged to submit their application at least six months prior to their desired term of entry.

* Required

General Information

* Program   Select one Bachelor of Science, General Science Associate of Applied Science, Chiropractic Technology * Anticipated Entry Select one March July November * Select one 2015 2016 2017 2018 2019 2020 * First Name   Middle Name * Last Name   Preferred Name Previous Name * Email * Phone (use dashes) Cell Home Work Secondary Phone Cell Home Work

Mailing Address (for all correspondence)

* Street   * City   * State / Province   * Postal Code   * Country   Is this your Permanent Address? Yes No

Background Information

* Date of Birth (mm / dd / yyyy)   Birth Nation * U.S. Citizen   Select one Yes No * Have you ever been convicted of, plead guilty to, plead no contest to, or forfeited bail for any
criminal conduct under law or ordinance excluding any minor traffic violations? Select one Yes No Emergency Contact: Name, Relationship and Contact Information (1 - 2 people)

Educational Information

* How did you hear about us?   Select one Chiropractor: from Palmer Chiropractor: not from Palmer Chiropractor: family member Admissions Representative Palmer Student Palmer Web Site Other Web Site Other...

List all institutions you have attended (chronologically). Do not abbreviate.

High School City, State Year of Graduation (YYYY) G.E.D. location and date Have you attended College? No Yes * Have you been dismissed from school?   Select one Yes No Are you planning, or currently taking, prerequisite coursework? No Yes Completed Semester Hours to date ... 0 - 30 31 - 90 91 - 120 121 +

Voluntary Information

Ethnicity ... Unknown Non-Resident Alien Hispanic or Latino American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Pacific Islander White Two or more races, not Hispanic or Latino Other ... Other Gender ... Male Female Marital Status ... Married Single Widowed Divorced Number of Children

Who was most influential in your decision to apply?

Name Address City, State, Postal Code Country Graduate of... Do you have any relatives who are graduates of Palmer?

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To finish your application process you must also:

• Print, sign and return the application certification form (PDF)
• Include a $50150 non-refundable application and evaluation processing fee
• Official transcripts from all high schools and attended/attending colleges must be sent directly from the school or college.
• Print, sign and return the Evaluation form (PDF)

Note: Supporting documents will be held for 30 days without an application.

Department of Undergraduate Studies
Palmer College of Chiropractic
1000 Brady Street
Davenport, Iowa 52803-9989

Undergrad@palmer.edu

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Do you agree to the following?

• I am submitting this form which serves as my authorization to Palmer College of Chiropractic to process my application.
• I certify the information submitted in my application form is correct and accurate and realize that failure to provide official transcripts and other required information may result in the cancellation of admission or registration.
• I understand that revocation of this application must be made in writing and sent to the Office of College Enrollment at Palmer College of Chiropractic.
• I agree and understand that I am to notify the Admissions Department (in writing), if I am convicted / plead guilty / plead no contest to / forfeit bail for any criminal conduct under law or ordinance excluding any minor traffic violations.
• I understand that a complete background check is required prior to matriculation into any of Palmer’s programs.
• I agree and understand that I am to notify the Admissions Department (in writing), if I am dropped or dismissed from a college, graduate or professional school.
• I understand that my application will not be processed until I have paid the $15050 application fee.

* ... I Agree

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* Payment Method   ... Pay online Mail check Email Code

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Notice of Non-Discrimination and Reservation of Rights > View Notice

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Application Procedures
Applicants are promptly notified as documents are received and each step of the application is completed. Only written communication directly from Undergraduate Studies shall be considered official. Acceptance is based on the approval of the completed file. Applicants will be notified of their current status. The balance of the first academic term tuition is due on orientation day. If the applicant does not begin Palmer in the academic term requested and Undergraduate Studies is unable to make contact, the file will be destroyed. The prospective student must then reapply and resubmit all necessary documents.