WESTERN UNIVERSITY OF HEALTH SCIENCES

DOCTOR OF DENTAL MEDICINE (DMD) PROGRAM

Prerequisite Worksheet
To be included with Secondary Application

Last Name: _________________________________ First Name: ________________________ MI: ______

AADSAS No: _______________________________ Birth Date: ________________________

Date Secondary Application Submitted: ________________________________

Please list prerequisite coursework (completed, in progress, and planned).

Please read the following:
Fill in rows that apply to the specific courses you have taken or will take to satisfy the pre-requisites.
Additional spacing has been provided for both semester and quarter schools systems.
Specify a different course for each Required Course category.
If the course is currently being/will be taken, indicate IP in the Grade column.
The number of courses you took in the series course categories (i.e. Physics) may vary, and some may have integrated
laboratories. Fill in rows and specify courses with laboratories as appropriate.
Complete this table using Dept code and Course # identical to transcript designations.
All prerequisite courses must be completed with a grade of C (or equivalent) or higher prior to matriculation.
A grade of C- or lower is not acceptable.

*Term (FA=Fall, SP=Spring, SU=Summer, WI=Winter)

Units
Name of Institution Dept Course Complete Course *Term/ Semester=S Grade
Required Courses
(Do not abbreviate) Code Number Title Year or (or IP)
Quarter=Q
Example: Freeway University CHE 101 General Chemistry FA10 4Q A-
Chemistry
(Semester or Quarter 1)
Lab Incl? Yes No
Chemistry
(Semester or Quarter 2)
Lab Incl? Yes No
Chemistry
(Quarter 3)
Lab Incl? Yes No
Chemistry Lab
(Semester or Quarter 1)
(Only if lab not included)
Chemistry Lab
(Semester or Quarter 2)
(Only if lab not included)
Chemistry Lab
(Quarter 3)
(Only if lab not included)
Organic Chemistry
(Semester or Quarter 1)
Lab Incl? Yes No
Organic Chemistry
(Semester or Quarter 2)
Lab Incl? Yes No
Organic Chemistry
(Quarter 3)
Lab Incl? Yes No

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 Units
Addl Required Name of Institution Dept Course Complete Course *Term/ Semester=S Grade
Courses (Do not abbreviate) Code Number Title Year or (or IP)
Quarter=Q
Example: Freeway University CHE 101 General Chemistry FA10 4Q A-
Organic Chemistry Lab
(Semester or Quarter 1)
(Only if lab not included)
Organic Chemistry Lab
(Semester or Quarter 2)
(Only if lab not included)
Organic Chemistry Lab
(Quarter 3)
(Only if lab not included)
Physics
(Semester or Quarter 1)
Lab Incl? Yes No
Physics
(Semester or Quarter 2)
Lab Incl? Yes No
Physics
(Quarter 3)
Lab Incl? Yes No
Physics Lab
(Semester or Quarter 1)
(Only if lab not included)
Physics Lab
(Semester or Quarter 2)
(Only if lab not included)
Physics Lab
(Quarter 3)
(Only if lab not included)
Biology
(Semester or Quarter 1)
Lab Incl? Yes No
Biology
(Semester or Quarter 2)
Lab Incl? Yes No
Biology
(Quarter 3)
Lab Incl? Yes No
Biology Lab
(Semester or Quarter 1)
(Only if lab not included)
Biology Lab
(Semester or Quarter 2)
(Only if lab not included)
Biology Lab
(Quarter 3)
(Only if lab not included)
English Composition

English Composition

English Composition

All required prerequisites taken in California community colleges must be transferable to the University of California (UC) or
California State University (CSU) system
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Important Notice to the Applicant:
You must inform the admissions office via e-mail, of any changes to the work in progress listed above.

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