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Other Information

Military Status

If you have US military experience, select your anticipated status at the time of enrollment from the drop-down. Select Not a member of the military if this does not apply.

Military Discharge

Select whether you were honorably discharged from the military. If you select No, indicate why you were not honorably discharged.

Felony and Misdemeanor Convictions

Indicate whether you've ever been convicted of a misdemeanor or felony. Failure to disclose and provide accurate information about prior convictions may have serious consequences, such as annulment of acceptance offers, program dismissal, or other sanctions.

Be aware of the potential impact on program acceptance. Contact the programs you wish to apply to for advice if you have a felony conviction or a criminal record. If you are uncertain of the status of a charge versus a conviction on your record, or if you are uncertain as to whether your offense was an infraction, misdemeanor, or a felony, contact the city, county, or state jurisdiction where the incident occurred.

If you are convicted of a misdemeanor or felony prior to admission and/or matriculation, it is your responsibility to immediately inform your program(s).

Academic Infraction

Indicate whether you have ever been disciplined or placed on academic probation while attending an academic institution. If you select Yes, enter a brief explanation in the field provided. Include 1) a brief description of the incident, 2) specific charge made, 3) related dates, 4) consequence, and 5) a reflection on the incident and how the incident has impacted your life.

License Infraction

Indicate whether you have ever had any certification, registration, license, or clinical privileges revoked, suspended, or in any way restricted by an institution, state, or locality. If yes, enter an explanation in the spaces provided.

Background Information

Programs fully recognize the importance of diversity in their student body and in the workforce. Accordingly, programs strongly encourage applications from persons from all socioeconomic, racial, ethnic, religious, and educational backgrounds and persons from groups underrepresented in the industry. Select any and all of the options in this section which you feel best apply to you. Please note that UTHSC uses this section for statistical purposes only and it in no way affects your application or financial aid eligibility.

Low Income Levels Guidelines

If applicable, use the following chart to help you determine if you come from an economically disadvantaged background.

Size of Family*

Income Level**

1

$27,180

2

$36,620

3

$46,060

4

$55,500

5

$64,940

6

$74,380

7

$83,820

8

$93,260

For each additional person add:

$9,440

The low income level is based on 200 percent of the U.S. Department of Health and Human Services poverty guidelines. It is used to determine what constitutes a low-income family for the purposes of the SDS and LDS programs.

* Size of family means the number of exemptions listed on the qualified income tax return forms. For example, a family size of 4 may include two parents and two dependents.

** Income Level refers to the adjusted gross income stated on the federal income tax return 1040 or 1040A.

Social Security Number

Enter your social security number. This field is optional, but some programs may require it for their application, or for institutional or federal financial aid forms. Contact your programs directly to determine if they require you to enter your social security number.

Denied Readmission

Indicate whether you have ever been denied readmission to an academic program due to academic conduct or performance. If yes, enter an explanation in the space provided.

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