Elements- Request for InformationAt Albany College of Pharmacy and Health Sciences, we provide you with the tools for success. These tools, combined with your passion for advancing the future of medicine and health science, will lead to endless new possibilities. To get a jump start on your pathway to success, provide us with your information below.Loading...Student First NameStudent Last NameEmail AddressMailing AddressMailing AddressCountryStreetCityRegionPostal CodeWould your Parent/Guardian like to receive information from us?Would your Parent/Guardian like to receive information from us?YesNoParent/Guardian First NameParent/Guardian Last NameParent/Guardian EmailPrimary PhonePrimary PhoneHomeCellParent CellCell Phone NumberCan we text you?Can we text you?YesNoHome NumberParent Cell Phone NumberBirthdateBirthdateJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember1234567891011121314151617181920212223242526272829303120242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900I am currently a...I am currently a...High School StudentCollege StudentCollege GraduateExpected High School GraduationExpected High School GraduationJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044What school are you attending currently?What program(s) are you interested in?What program(s) are you interested in?Doctor of PharmacyB.S. BiologyB.S. Biomedical TechnologyB.S. Clinical Laboratory SciencesB.S. Health SciencesB.S. MicrobiologyB.S. Pharmaceutical SciencesB.S. Public HealthWhat pre-professional option(s) are you interested in?What pre-professional option(s) are you interested in?Pre-ChiropracticPre-DentalPre-LawPre-MedPre-Occupational TherapyPre-OptometryPre-Physical TherapyPre-Physician AssistantPre-PodiatryPre-VetWhat is your expected college entry term?Fall 2024Spring 2025Fall 2025Spring 2026Fall 2026Spring 2027Fall 2027Would you like your Admissions Counselor to contact you directly?Would you like your Admissions Counselor to contact you directly?Yes, by emailYes, by phoneDo you want to schedule a visit to campus?Do you want to schedule a visit to campus?YesNoSchedule a visit:Schedule a visit:Monday, November 25 at 09:00 AM - On Campus TourFullMonday, November 25 at 02:00 PM - On Campus TourFullTuesday, November 26 at 09:00 AM - On Campus TourFullTuesday, November 26 at 02:00 PM - On Campus TourFullHow did you hear about ACPHS?How did you hear about ACPHS?AdmissionsBrochureMall Kiosk AdMovie Theater AdSocial MediaWeb SearchWord of MouthOtherPlease describe:Which platform?Which platform?FacebookInstagramPandoraSpotifyOtherPlease describe:By whom?By whom?ACPHS AlumnusCurrent ACPHS StudentFriendGuidance Counselor/Academic AdvisorPharmacistProfessional OrganizationRepresentative visited your schoolTeacher/ProfessorHow?How?College Night/FairMailingAdmission Counselor visited your schoolWhich one?Where on the web?Where on the web?GoogleInternet Banner AdMyCollegeOptionsNavianceNicheOtherPlease describe:Submit
