Gluck Center

Applicant Information Form Update

If you move and/or change your telephone numbers or e-mail address, let us know. Otherwise, important updates may not reach you in time.

Maxwell H.Gluck Equine Research Center
Department of Veterinary Science, University of Kentucky
Lexington, Kentucky 40546-0099

Main Office (859) 257-4757
Fax (859) 257-8542

Today's date	Please enter today's date.
Your full name	Please enter your full name.

Only submit NEW information.

Will you be a UK student as of Summer or Fall 2013?	Yes No

E-mail address (use uky.edu acct; hotmail and some others do not work)

Phone	Please provide both Home and Cell phone numbers if you have both.

May Dr. Dwyer call you at work if necessary?	Yes No
	If yes, work phone:

Local mailing address

Permanent home address If same as local, enter "same".

May Dr. Dwyer call you at your permanent home phone if necessary?	Yes No
	If yes, permanent home phone:

Where are you applying:	Auburn University Tuskegee University Other

Are you a re-applicant to Auburn?	Yes No

List all Universities and Colleges attended, including UK:

Are you a legal KY resident?	Yes No

Will you have a college undergraduate degree by June 1, 2014?	Yes No
	If yes, Institution and month/year:

Will you have an advanced degree (MS, PhD, etc) by June 1, 2014?	Yes No
	If yes, Institution and month/year:

At this time, what type of animals are you most interested in? (maximum of 3 choices)	Haven't decided - interested in all animals now. Small animals Horses Food animals (cattle, sheep, goats, llamas, etc.) Exotics (pet birds, reptiles, etc.) Zoo animal/wildlife medicine Other, please specify: (eg. research, teaching, public health, regulatory, etc.)