Basic Health Science Form Current Your Information Course Credits Complete Your Information First Name Last Name Email Current Status - Select - Active Duty Civilian NG or Reserve Address City/Town State/Province - Select - Alabama Alaska American Samoa Arizona Arkansas Armed Forces (Canada, Europe, Africa, or Middle East) Armed Forces Americas Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ZIP/Postal Code Recruiter Information Required for civilian/NG/Reserve status applicants only; you may submit the BHS form prior to obtaining a Medical Recruiting however one is required and must be reported prior to potentially attending an interview. To Request a Medical Recruiter or Report contact data for your Medical Recruiter, use the related forms linked inside the chart for application requirement #1. Recruiter's Rank Recruiter's Email