College of Health Science

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Student Information

Legal First Name

Preferred First Name

Legal Last Name

Birthdate

Confirm Email

Mobile Phone

Would you like to receive text messages from Pepperdine?

Yes

Student Address

Mailing Address

Country

Street

City

Region

Postal Code

Student Details

Religious Preference

Citizenship Type

Country of Citizenship

HIDDEN: US Citizenship

Parent/Guardian/Caretaker Information

Would you like to add a parent/guardian/caretaker to be included in emails?

Yes

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Relationship to Student

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Additional Parent/Guardian/Caretaker Information

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Relationship to Student

Becoming a Student

Term of Interest

Student Type

First-Year

Transfer

Current/Most Recent High School
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Current/Most Recent College or University
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Intended Major

Yes, I agree