Prospective Student Request Form
Thank you for your interest in the Doctor of Optometry program at the University of Alabama in Birmingham. Your request for information is greatly appreciated. Please fill out the inquiry form below and submit it. You will receive the requested information in 7-10 business days. Your contact information will be added to our database so that we can send you updates in the future.
First Name:
Last Name:
Street Address Line 1:
City:
State or Province:
   
Postal Code:
Country:
Email Address:
 
Preferred Phone:
 
Alternate Phone:
   
Year in School:
School Attending or Attended:
Date of Expected Graduation or Graduation:
Degree Expected or Earned:
Questions for the UABSO Admissions Office:
Street Address Line 2:
                   
MM/DD/YYYY