State/Country of Legal Residence

Health Professions Advisory Committee Letter Application

Last Name: First Name: M.I.:

State/Country of Legal Residence:

GWID: AMCAS/AADSAS ID: TMDSAS/AACOMAS ID:

Email Address: Phone:

I will be applying to (check all that apply):

MD programs (Allopathic medical school) Dental schools MD/PhD programs Post-baccalaureate programs DO programs (Osteopathic medical school) Other: ______

Have you ever been evaluated by the GW Health Professions Advisory Committee in the past? If yes, what year?

Yes Year: No

Have you applied to professional school in the past (NOT INCLUDING GW’s Early Selection Program)? If yes, what year?

Yes Year: No

I will be submitting letters of recommendation from the following individuals:

Name of Recommendation Writer Writer’s title/role

I have provided each letter writer with the Guidelines for Recommendation Letters Writers. Health Professions Advisory Committee Letter Application

SUPPLEMENTAL INFORMATION QUESTIONS Please take your time when completing this information as it may be used in part to construct the committee letter. You must respond within the allotted space. Text must be 11 pt and Times New Roman font.

1. Tell us about your experiences in the clinical setting. Did you have contact with patients? How so?

2. How have you served your community, both at GW and outside of GW? How has your community involvement helped prepare you for the practice of medicine or dentistry?

3. What research experience do you have? Was it wet lab/bench work?

4. As a physician/dentist, you will work on a healthcare team. What experience has prepared you for this?

5. What is the greatest strength of your medical/dental school application?

6. What is the greatest weakness of your medical/dental school application? How have you worked to address this weakness?

7. What are your plans for the next year?

8. What might your career trajectory look like if you are not accepted to medical or dental school?

9. Were you ever the recipient of any action by any college, university, or professional school for unacceptable academic performance (e.g. dismissal, disqualification, suspension, etc.) or conduct violation(s) (to include any administrative or judicial record or any record that has been expunged)? If yes, please explain the circumstances and consequences.

NOTE: The HPAC Committee will contact the Office of Student Rights and Responsibilities to check your record. If there is conflicting information, you will be disqualified from participating in HPAC.

10. Please list ten activities or jobs (both health-related and otherwise) you have pursued since entering college that have contributed to your preparation for medical or dental school. Since you may only list ten, Health Professions Advisory Committee Letter Application please select the experiences that were most valuable to you. Please list chronologically with your most recent experience first.

Dates Hours/ Paid? Supervisor Title & Location Brief Description of Responsibilities (From-To) Week Y/N name/title PERSONAL STATEMENT Your essay should be no more than 5300 characters (including spaces, 10pt font) and can address the following questions:  Why have you selected the field of medicine/dentistry?  What motivates you to learn more about medicine/dentistry?  What do you want medical /dental schools to know about you that hasn't been disclosed in other sections of the application?  Special hardships, challenges, or obstacles that may have influenced your educational pursuits.  Commentary on significant fluctuations in your academic record that are not explained elsewhere.