Plantrician University Student/Faculty Enrollment

Student/Faculty Enrollment Form

Are you a student or faculty? *

University/School Name *

Title *

Department *

Teaching Major/Focus/Specialty *

Upload Proof of Faculty Status (mandatory for approval) *

Current Education Level *

Plantrician University is intended for matriculated students interested in pursuing a career in healthcare. Please select the degree level for which you are currently matriculated.

Degree Program *

Major/Focus/Specialty *

Expected Date of Graduation/Residency Completion (Required for Students/Residents) *

University/School Name *

Upload Proof of Your Matriculation (mandatory for approval) *

Student/Faculty I.D. or Term Bill/Schedule Drop files here or Select files Accepted file types: jpg, pdf, png, Max. file size: 50 MB

First Name *

Please input your name exactly as it appears on your identification.

Last Name *

Please input your name exactly as it appears on your identification.

Email *

Please use your personal email address if you have one. Not your school or professional email address.

Mobile Phone *

Please enter your full phone number including country and area code here. Example: 1-555-398-1234 or 44 201 234 1234

Username *

Your Location

Country *

City *

Select State *

Student/Faculty Enrollment Form

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