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Muskingum Adult Program Student Interest Form (MAP)
Please submit your personal information so that we can keep you informed of upcoming events and registration timelines.
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*Denotes Required
By the time you start at Muskingum, how far along will you be in your education?
By the time you start at Muskingum, how far along will you be in your education?
High School Diploma or GED
I will have completed an RN Program (Registered Nurse)
Some college
Associate's degree
Bachelor's degree
Master's degree
Which Associate's Degree?
Which Associate's Degree?
Nursing
Medical Laboratory Technology
Occupational Therapy Assistant
Other
Which program are you interested in?
Which program are you interested in?
Accelerated Bachelor's Degree in Nursing (ABSN)
A second Bachelor's Degree (other than Nursing)
Master's of Occupational Therapy (MOT)
Other Graduate Degree (Master's or Doctorate Degree)
Please contact our other graduate program options
.
How would you like to take classes at Muskingum?
How would you like to take classes at Muskingum?
In-person classes
Online classes
Please fill out this form instead
.
Contact/Address Information
*
Email Address
*
First Name
Middle Name
*
Last Name
*
Mailing Address
*
Mailing Address
Country
Street
City
Region
Postal Code
*
Phone Number
Most Recently Attended School
Most recently attended school
Most recently attended school
High School
College / University Credit
*
School Name
School CEEB
Academic Information
*
Academic Interest
Accelerated BSN
Business Management
Community Health and Wellness
Health Science
Healthcare Management
Inclusive Primary Education and Special Education
Intervention Specialist (Special Education)
Master of Occupational Therapy Bridge Program
Medical Laboratory Studies
Nursing (RN to BSN)
Occupational Science
Primary Education
Not finding what you're looking for? We have other options available through our traditional on-campus programs. See available options
on this form
.
When do you plan to begin at Muskingum?
'25 Spring I (Jan 13-Mar 7)
'25 Spring II (Mar-May)
'25 Summer (May-Jul)
'25 Fall I (Aug-Oct)
'25 Fall II (Oct-Dec)
How did you hear about Muskingum's Adult Program?
Parent
Alumni
Representative at my school/college fair
Coach
Friend
Reputation
Phone Call
Text Message
Email
Website
Employer
Social Media
Other
List your questions below:
*
Are you a licensed OTA
*
Are you a licensed OTA
Yes
No
*
What allied health degree do you currently hold?
*
What allied health degree do you currently hold?
OTA student
Hold a bachelor's degree in an alternate allied health field
Other
*
Please list your degree
*
Other, please describe.
MAP Interest HIDDEN
MAP Interest HIDDEN
Yes
No
Submit
