Permanent street address:
Last 4 digits of your Social Security #:
Please provide information that you believe should be considered by the Office of Student Affairs and Admissions in considering you as a participant in the Prematriculation Program:
Please provide a summary of your activities during the past year or since your AMCAS application was submitted:
List courses and grades for the past year (specifically, information not included on the AMCAS application):
For more information, contact the Office of Student Affairs and Admissions at email@example.com.
Gary LeRoy, M.D., Associate Dean
190 White Hall
Boonshoft School of Medicine
Wright State University
3640 Colonel Glenn Highway
Dayton, OH 45435
Admissions: Gwen Sloas, Ed.D.
Diversity & Inclusion: Kevin J. Watt, M.D.
Financial Aid: Michelle Feichtner
Student Affairs & Admissions
WSU Boonshoft School of Medicine
P.O. Box 1751
Dayton, OH 45401-1751
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