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Optometry
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Why UPIKE?
Life at UPIKE
Undergrad Inquiry Form
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How will you be starting at UPIKE?
Undergraduate Freshman
Graduate (OD/DO/MSW/MBA)
Transfer to UPIKE
Thank you for your interest in one of our graduate level programs.
This form is for information about our undergraduate programs only. For information about our various graduate opportunities, please contact the individual below directly.
Optometry School
David Roberson
kycoadmissions@upike.edu
606-218-5286
Osteopathic Medicine School
Jennifer Lockhart
kycomadmissions@upike.edu
606-218-5288
Online Programs
Meredith Campbell
meredithcampbell@upike.edu
606-218-4459
*
When do you plan to start at UPIKE?
Fall 2021
Fall 2022
Fall 2023
Fall 2024
May 2021
Spring 2021
Spring 2022
Spring 2023
Spring 2024
Spring 2025
Summer I 2021
Summer II 2021
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Anticipated Academic Major
Art
Biology
Business Administration - Accounting
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Chemistry
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Criminal Justice
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Mathematics
Music
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Nursing - R.N. to B.S.N.
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Pre-Professional (Engineering)
Pre-Professional (Law)
Pre-Professional (Medicine)
Pre-Professional (Optometry)
Pre-Professional (Pharmacy)
Pre-Professional (Physical Therapy)
Pre-Professional (Veterinary Medicine)
Psychology
Religion
Social Work
Sociology
Spanish
Teacher Leader Program
Undecided
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First Name
Middle Name
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Last Name
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Birthdate
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Birthdate
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Phone Number
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Email address
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Mailing Address
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Mailing Address
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Academic Information
Are/were you a home schooled student?
Are/were you a home schooled student?
Yes
No
High School Graduation Date
High School Graduation Date
January
February
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April
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High School
High School CEEB code
Interest 1
Academic Team
Archery
Arts
Band
Baseball
Basketball
Biology/Biological Sciences
Bowling
Broadcasting/Radio/TV
Business
Cheerleading
Chemistry
Choir
Communications
Criminal Justice
Cross Country
Dance
Debate
Esports
Film & Media Arts
Football
Golf
Greek Life
Honors Club
Mathematics
Optometric Scholars Program
Osteopathic Medical Scholars Program
Political science and government
Religious Activities
Soccer
Softball
Student Government
Study Abroad
Swimming
Tennis
Theatre
Track & Field
Tutoring
Volleyball
Volunteer
Interest 2
Academic Team
Archery
Arts
Band
Baseball
Basketball
Biology/Biological Sciences
Bowling
Broadcasting/Radio/TV
Business
Cheerleading
Chemistry
Choir
Communications
Criminal Justice
Cross Country
Dance
Debate
Esports
Film & Media Arts
Football
Golf
Greek Life
Honors Club
Mathematics
Optometric Scholars Program
Osteopathic Medical Scholars Program
Political science and government
Religious Activities
Soccer
Softball
Student Government
Study Abroad
Swimming
Tennis
Theatre
Track & Field
Tutoring
Volleyball
Volunteer
Interest 3
Academic Team
Archery
Arts
Band
Baseball
Basketball
Biology/Biological Sciences
Bowling
Broadcasting/Radio/TV
Business
Cheerleading
Chemistry
Choir
Communications
Criminal Justice
Cross Country
Dance
Debate
Esports
Film & Media Arts
Football
Golf
Greek Life
Honors Club
Mathematics
Optometric Scholars Program
Osteopathic Medical Scholars Program
Political science and government
Religious Activities
Soccer
Softball
Student Government
Study Abroad
Swimming
Tennis
Theatre
Track & Field
Tutoring
Volleyball
Volunteer
Parent/Guardian 1
Prefix
Dr.
Mr.
Mrs.
Ms.
First Name
Last Name
Email
Relationship to you?
Brother
Father
Friend
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Grandmother
Legal Guardian
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Other
Sister
Step-Father
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Would you like to add another Parent/Guardian?
Yes
No
Parent/Guardian 2
*
Prefix
Dr.
Mr.
Mrs.
Ms.
*
First Name
*
Last Name
*
Email
*
Relationship to you?
Brother
Father
Friend
Grandfather
Grandmother
Legal Guardian
Mother
Other
Sister
Step-Father
Step-Mother
Submit