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Cal Poly Pomona

Online Registration for MDPT

NEWS FLASH! The current online registration is for July 26th, 2008 test.  The deadline to register is on or before July 11th, 2008 5:15 PM. 

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 (Ms. Nora Babinski) in Bldg. 8 - Rm 111 or call (909) 869-4676.

Your name as it appears on your photo ID:

First name:
Middle name:
Last Name:

Enter your 9 Digit 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.

Name:

Address:
City, State, Zip Code:

Check that you are using a valid e-mail address and that it is correct. Cal Poly is username@csupomona.edu. The email response to this form is your primary confirmation for MDPT registration.

Your E-mail address:

Confirm E-mail address: