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Online Registration for MDPT
 
This registration is for July 10, 2004 tests. The form below must be submitted no later than June 25, 2004.

Please provide ALL of the information requested, and then click on "Submit Form". Upon submission a new web page will be generated that contains all of the data that you entered. Be sure to check it closely for any mistakes. Print this page. This is your proof that you did register on-line.

You will be mailed an Admission Ticket with the test time, location, and other information about two weeks before the test.

Please provide an appropriate address for that period of time. If you have not received a response by the Monday before the test date, notify the MDPT Coordinator in Bldg. 8 - Rm 106 or call (909) 869-4676.

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Your name as it appears on your photo ID:
First name:
Middle name:
Last Name:

Enter your BroncoNumber (Not Social Security Number): - -

What is your major?

Into which course do you want to place (select one)?









Select the MDPT you wish to take (select one):


Your name and address to be used for the mailing label for your admission ticket.
Please type your name and address (Please use CAPs for name and address!) exactly as it should appear on the label.


Your E-mail address:

 

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Please send comments or report problems to Dr. Hoon Kim or Dr.Weiqing Xie.
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