Application Must Be Received in Full by Wednesday, March 8Th, 2017 No Later Than 4:00Pm

2 Science – Technology – Academics – Research 2017 Student Application

Application must be received in full by Wednesday, March 8th, 2017 no later than 4:00pm. Hand delivery of application is preferred. If you are mailing the application, please do so well in advance of the due date. Before you begin, please review the following application directions and program information. Important Dates (for more information on these events, please call Academic Outreach at 504-842-1286) Wednesday, February 8th, 5:30-6:30pm 2017 STAR Informational for interested students, parents, teachers, administrators, counselors, and community members Wednesday, March 8th, 4:00pm Full application packets due to the Academic Outreach Office April 2016 Interviews will be held for students who have been accepted into the interview round Tuesday, May 2nd Acceptance Day (accepted student & parent attendance is required) Thursday, May 18th 2017 STAR Meet & Greet for accepted students and parents (accepted student & parent attendance is required) Monday, June 19th – Friday, July 14th 2017 STAR Program; Monday through Friday, 8:00am – 4:00pm Friday, July 14th 2017 STAR Culmination Luncheon (student attendance required & parent attendance encouraged) Application Submission Instructions  Applicants must turn in one envelope with all items enclosed. (See checklist below for required contents.)  The application must be completed in full. Applications with unanswered questions will be considered incomplete. Envelopes with missing contents will be considered incomplete. Incomplete applications will not be reviewed.  Applicants must have two recommenders. Each recommender must fill out the recommendation form and write a recommendation letter. It is the students’ responsibility to ensure that each form and letter set is enclosed in an envelope that is sealed and signed by the recommender, and submitted INSIDE the full application envelope.  Transcripts must be submitted in an envelope that is sealed and signed by the appropriate school administrator.  Applications may be submitted through the postal service, but it is preferred that full packets be turned in directly to the Academic Outreach Office. If you are mailing your application, it must be received by the deadline. The address for submission is listed on the last page of the application. Applications will not be accepted by fax or through e-mail. Program Information and Requirements  Louisiana residents will be given priority selection for the STAR Program.  Applicants must have at least one reliable form of transportation already in place.  Accepted students and at least 1 parent/guardian are required to attend Acceptance Day and Meet & Greet. Students are required to attend the Culmination Ceremony, and parent attendance is encouraged.  Accepted students are allowed only two days of absence throughout the program.  Accepted students will be required to submit an up-to-date immunization record, complete a tuberculosis questionnaire, and pass a drug screening.  Applicants must be at least 16 years old by June 19th, 2017.  STAR is open only to students who are advancing into the 12th grade.

2 Instruction Page PART I-a: Student Information Name: ______Last, First Middle Initial Date of Birth: / / Sex: M F Month Day Year Address: Street Number Street Name City, State Zip Code Parish of Residence: ______

Primary Phone: ()- Secondary Phone: ()-

Best time to call: Morning (8am – 11:30am) Afternoon (11:30am – 5pm) Evening (5pm – 8pm)

E-Mail Address: @. Current School: ____ Current Grade: ______Current School Type (select one): Public Private Other (please specify): _____ Current School Counselor or Principal’s name: ______ACT/SAT Score (if available): ______Ethnic Classification: White (Non-Hispanic) African-American Hispanic Hawaiian/Pacific Islander

American Indian Asian (please specify) __

Multiracial (please specify): ______

Other (please specify): ______

How did you find out about STAR? STAR Alumni Friend Teacher Counselor School Administrator

Ochsner Website Direct Mailing Ochsner Employee

Other (please specify______

Is this application a resubmission from a previous year? YES NO If YES, which year? _____

Is the applicant associated with or the immediate family member of any employee or staff member of Ochsner Health System? (for information purposes only; association does not offer selection preference). YES NO If YES, please list name, position and affiliation: ____ 4 ___

Emergency Contact: Name: ______Relationship to Student:______Primary Phone: ()- Secondary Phone: ()-_____ Work Phone: ()- Place of Employment: __ Page 1 (Continue to next page) PART I-b: Student Information Based on your preferences and career goals, choose the coursework that is most appealing to you. Choose exactly 10 preferences. Medical Terminology Ethical Treatment of Animals Physicians’ Assistant Rotation

Presentation Skills Leadership Development Hypertension Research

Laboratory Safety Clinical Research Psychiatry/Psychology

Pediatric Nursing Neurosurgery Cancer Research

Medical Publishing Cell Signaling & Immunoblotting Pathology

Public Health Emergency Department Robotics

Labor & Delivery Preventative Cardiology Pharmacy

PART II: Parent/Guardian Information Father/Guardian Information: Name: ____ Guardian Relationship:__ Address: ______Street Number Street Name City, State Zip Code Primary Phone: ()- Secondary Phone: ()-_____ Work Phone: ()- Place of Employment: _____ Employment Status of Father/Guardian (required): Employed Self-employed Homemaker Unemployed If applicable, list place of employment & occupation: ___ Highest level of education (required)

N/A High school diploma/GED Some college Associates or Bachelor’s Degree

Masters or Doctorate

Mother/Guardian Information: Name: ____ Guardian Relationship:__ Address: ______Street Number Street Name City, State Zip Code 4 Primary Phone: ()- Secondary Phone: ()-_____ Work Phone: ()- Place of Employment: _____ Employment Status of Father/Guardian (required): Employed Self-employed Homemaker Unemployed If applicable, list place of employment & occupation: ___ Highest level of education (required)

N/A High school diploma/GED Some college Associates or Bachelor’s Degree

Masters or Doctorate

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PART III: Short Answer (Answers should be typed either below or on a separate sheet of paper)

1.) Please list up to five school, community, and/or church activities in which you actively participate, and list leadership positions within these organizations that you have held or are currently holding. Of these, choose one leadership experience that has had the greatest impact on your life and elaborate on your duties within the position and what you have learned from this leadership experience. (maximum of 150 words)

2. In your own words, define the term “diversity.” Based on your own experience, give at least one example of how diversity has affected your life, and explain what that experience has taught you. (maximum of 150 words)

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PART III: Short Answer continued (Answers should be typed either below or on a separate sheet of paper)

4.) What are your hobbies and/or special interests? (maximum of 150 words)

6.) Why would you like to participate in the STAR Program, and how will your participation in STAR move you toward your future goals? (maximum of 150 words) 6

PART IV: Essay On a separate sheet of paper, submit an essay that answers the following statement: In 300-350 words, discuss an issue of national concern and its importance to you.

ESSAY REQUIREMENTS: (1) Minimum of 300 words – Maximum of 350 words; essays submitted that are above or below the word count threshold will have points deducted from the application. (2) Essays must be typed; hand written essays will not be accepted.

(Continue to next page) PART V: Future Plans After high school, I plan to attend: 4-year college 2-year college Vocational School Undecided

Other (please specify): ______

List your top 4 college choices in order of preference: 1.) _ 2.) ___ 3.) __ 4.) ___ Check intended college major: Agriculture Architecture Art/Design Biology/Microbiology Business Chemistry/Biochemistry Computer Science Dentistry Education/Counseling Engineering English Foreign Language History Interior Design Law/Pre-Law Mass Communications Mathematics/Physics Medicine Music Optometry Performing Arts Pharmacy Philosophy Photography Political Science Pre-Nursing/Nursing Psychology Sociology/Social Work Speech Communications Other______Undecided (Please rank your top three possibilities if you have marked undecided)

PART VI: Self-Evaluation Please rate yourself in each of the following categories Below Average Above by circling the appropriate number. Average Average Knowledge 1 2 3 4 5 6 7 8 9 Academic Intelligence 1 2 3 4 5 6 7 8 9 Qualification Academic Abilities 1 2 3 4 5 6 7 8 9 s Carries Out Assignments 1 2 3 4 5 6 7 8 9 Resourcefulness 1 2 3 4 5 6 7 8 9 Motivation 1 2 3 4 5 6 7 8 9 Creativity 1 2 3 4 5 6 7 8 9 Personal Responsibility 1 2 3 4 5 6 7 8 9 Academic Commitment 1 2 3 4 5 6 7 8 9 Potential to Succeed 1 2 3 4 5 6 7 8 9 Overall Academic Qualifications 1 2 3 4 5 6 7 8 9

Personal Maturity 1 2 3 4 5 6 7 8 9 Qualification Stability 1 2 3 4 5 6 7 8 9 6 s Initiative 1 2 3 4 5 6 7 8 9 Leadership 1 2 3 4 5 6 7 8 9 Interpersonal Skills 1 2 3 4 5 6 7 8 9 Openness 1 2 3 4 5 6 7 8 9 Empathy 1 2 3 4 5 6 7 8 9 Judgment 1 2 3 4 5 6 7 8 9 Communication Skills 1 2 3 4 5 6 7 8 9 Integrity 1 2 3 4 5 6 7 8 9 Social Awareness 1 2 3 4 5 6 7 8 9 Overall Personal Qualifications 1 2 3 4 5 6 7 8 9 Letters of Recommendation: Please include two letters of recommendation from non-family members. These individuals may be a teacher, school administrator, counselor, employer, church member, employee at an organization with which you have volunteered, or a close family friend. This person should be able to comment on your character, your commitment to academics, and your work ethic. Please ensure that the official recommendation forms are given to those individuals you will ask to write your letters of recommendation. To be considered complete, it is necessary that the admissions committee receive all recommendation documents enclosed in the envelope with the full application by the deadline date of Wednesday, March 8th at 4:00 p.m. Note: The recommendation form and letter must be enclosed in an envelope sealed and signed by the recommender. Official letterhead is preferred.

 How do I submit my complete application envelope? Applications may be dropped off to the Academic Outreach Office or mailed to the address below: Ochsner Academic Outreach Attn: Allison F. Sharai Academic Excellence Center 1401-A Jefferson Hwy New Orleans, LA 70121

*You are strongly encouraged to turn in your application before the due date. *Mailed applications must be in the Academic Outreach Office by the application due date, not postmarked by the due date. *No component of the application will be accepted by fax or e-mail. *Applications must be submitted in full. Individual components of the application will not be accepted if sent separately.

 How can I find out more information about STAR and speak to the administration and alumni? Attend the STAR 2017 Informational Session! STAR administrators will hold an informational session Wednesday, February 8 th from 5:30-6:30 p.m. at the Ochsner Medical Center – Jefferson Highway Campus. This event is free and open to interested students, parents, teachers, school administrators, counselors, and community members. Attendees are encouraged to RSVP for this event by calling 504-842-1286 or emailing [email protected].

 When and how will I be contacted if I have made it to the interview round? The top students, based on application contents, will be accepted into the 2 nd round of the application process, which is a formal interview with the STAR administration. Students who have been accepted into the interview round will be contacted by phone to schedule their interview date and time. Interviews will take place in the late afternoon/early evening on a weekday. Students will be notified by mail if they have not been accepted into this round.

 When and how will I be notified if I have been accepted into the STAR program? Students who have been accepted into the program will be notified by phone and will be required to attend the Acceptance Day with a parent, by appointment, on Tuesday, May 2nd. Two students will be accepted as alternates. Alternates will be accepted into the program in the event that one of the accepted students cannot fulfill the requirements. Alternates will be notified in early May as to whether or not they have been selected to participate.

 Whom do I contact if I have questions or need more information? www.ochsner.org/STAR Stephanie Messina, Academic Outreach Coordinator Rebecca Fisher, Academic Outreach Coordinator Office – 504-842-1286 Office – 504-842-3237 E-mail – [email protected] E-mail – [email protected]

Allison F. Sharai, Manager, Academic Outreach Office – 504-842-4712 E-mail – [email protected] Thank you for your application! Science-Technology-Academics-Research 2017 Student Recommendation Form

Application (including recommendations) is due in full by Wednesday, March 8th, 2017 no later than 4:00pm INSTRUCTIONS TO RECOMMENDER: We appreciate your willingness to serve as a reference for this student who is applying to Ochsner’s STAR Program. We are seeking motivated and mature students who are eager to learn and will be able to fulfill the scholastic requirements of Ochsner’s STAR Program. 1. Please attach both pages of this form to a separate Letter of Recommendation on your official letterhead detailing the candidate’s qualifications. 2. Seal the envelope and sign across the seal. 3. Give the completed envelope to the student to put into his/her application envelope for submission. This recommendation must be included in the students’ application submission packet and cannot be sent separately. 4. If STAR administration would like more information about the student applicant, one of the administrators will contact you.

RECOMMENDER, PLEASE PRINT THE INFORMATION REQUESTED BELOW:

STUDENT YOU ARE RECOMMENDING:______

YOUR NAME: ______

YOUR ORGANIZATION/COMPANY: ______

YOUR POSITION OR TITLE: ______

HOW LONG HAVE YOU KNOWN THIS APPLICANT: ______

RELATIONSHIP TO APPLICANT: ______

YOUR EMAIL ADDRESS: ______

PRIMARY PHONE NUMBER: (______) ______-______

SECONDARY PHONE NUMBER: (______) ______-______

MAILING ADDRESS: ______Street Number Street Name City, State Zip Code

Please continue to Page 2 Please compose a separate letter of recommendation printed on high school or organization letterhead that addresses one or more of the following topics:  The applicant’s strengths and weaknesses in terms of medical/scientific knowledge, attitude, skills, character, maturity, and interpersonal skills  The applicant’s potential as a successful leader and/or member of the community  The applicant’s commitment to diversity, collaboration, and service Please rate the applicant in each of the following Below Average Above Cannot categories by circling the appropriate number. Please be Average Average Rate as sincere as possible.

Academic Knowledge 1 2 3 4 5 6 7 8 9 N/A Qualifications Intelligence 1 2 3 4 5 6 7 8 9 N/A Academic Abilities 1 2 3 4 5 6 7 8 9 N/A Carries Out Assignments 1 2 3 4 5 6 7 8 9 N/A Resourcefulness 1 2 3 4 5 6 7 8 9 N/A Motivation 1 2 3 4 5 6 7 8 9 N/A Creativity 1 2 3 4 5 6 7 8 9 N/A Personal Responsibility 1 2 3 4 5 6 7 8 9 N/A Academic Commitment 1 2 3 4 5 6 7 8 9 N/A Potential to Succeed 1 2 3 4 5 6 7 8 9 N/A Overall Academic Qualifications 1 2 3 4 5 6 7 8 9 N/A

Personal Maturity 1 2 3 4 5 6 7 8 9 N/A Qualifications Stability 1 2 3 4 5 6 7 8 9 N/A Initiative 1 2 3 4 5 6 7 8 9 N/A Leadership 1 2 3 4 5 6 7 8 9 N/A Interpersonal Skills 1 2 3 4 5 6 7 8 9 N/A Openness 1 2 3 4 5 6 7 8 9 N/A Empathy 1 2 3 4 5 6 7 8 9 N/A Judgment 1 2 3 4 5 6 7 8 9 N/A Communication Skills 1 2 3 4 5 6 7 8 9 N/A Integrity 1 2 3 4 5 6 7 8 9 N/A Social Awareness 1 2 3 4 5 6 7 8 9 N/A Overall Personal Qualifications 1 2 3 4 5 6 7 8 9 N/A

In rating the applicant, who is your basis of comparison? Other students Other employees Other volunteers Other ______What is your overall recommendation of the candidate? Highly Recommended Recommended Recommended with Reservations Not Recommended If you have not recommended or recommended the applicant with reservations, please give a brief explanation. ______RECOMMENDER SIGNATURE DATE THANK YOU! Science-Technology-Academics-Research 2017 Student Recommendation Form

Application (including recommendations) is due in full by Wednesday, March 8th, 2017 no later than 4:00pm INSTRUCTIONS TO RECOMMENDER: We appreciate your willingness to serve as a reference for this student who is applying to Ochsner’s STAR Program. We are seeking motivated and mature students who are eager to learn and will be able to fulfill the scholastic requirements of Ochsner’s STAR Program. 5. Please attach both pages of this form to a separate Letter of Recommendation on your official letterhead detailing the candidate’s qualifications. 6. Seal the envelope and sign across the seal. 7. Give the completed envelope to the student to put into his/her application envelope for submission. This recommendation must be included in the students’ application submission packet and cannot be sent separately. 8. If STAR administration would like more information about the student applicant, one of the administrators will contact you.

RECOMMENDER, PLEASE PRINT THE INFORMATION REQUESTED BELOW:

STUDENT YOU ARE RECOMMENDING:______

YOUR NAME: ______

YOUR ORGANIZATION/COMPANY: ______

YOUR POSITION OR TITLE: ______

HOW LONG HAVE YOU KNOWN THIS APPLICANT: ______

RELATIONSHIP TO APPLICANT: ______

YOUR EMAIL ADDRESS: ______

PRIMARY PHONE NUMBER: (______) ______-______

SECONDARY PHONE NUMBER: (______) ______-______

MAILING ADDRESS: ______Street Number Street Name City, State Zip Code

Please continue to Page 2 Please compose a separate letter of recommendation printed on high school or organization letterhead that addresses one or more of the following topics:  The applicant’s strengths and weaknesses in terms of medical/scientific knowledge, attitude, skills, character, maturity, and interpersonal skills  The applicant’s potential as a successful leader and/or member of the community  The applicant’s commitment to diversity, collaboration, and service Please rate the applicant in each of the following Below Average Above Cannot categories by circling the appropriate number. Please be Average Average Rate as sincere as possible.

Academic Knowledge 1 2 3 4 5 6 7 8 9 N/A Qualifications Intelligence 1 2 3 4 5 6 7 8 9 N/A Academic Abilities 1 2 3 4 5 6 7 8 9 N/A Carries Out Assignments 1 2 3 4 5 6 7 8 9 N/A Resourcefulness 1 2 3 4 5 6 7 8 9 N/A Motivation 1 2 3 4 5 6 7 8 9 N/A Creativity 1 2 3 4 5 6 7 8 9 N/A Personal Responsibility 1 2 3 4 5 6 7 8 9 N/A Academic Commitment 1 2 3 4 5 6 7 8 9 N/A Potential to Succeed 1 2 3 4 5 6 7 8 9 N/A Overall Academic Qualifications 1 2 3 4 5 6 7 8 9 N/A

Personal Maturity 1 2 3 4 5 6 7 8 9 N/A Qualifications Stability 1 2 3 4 5 6 7 8 9 N/A Initiative 1 2 3 4 5 6 7 8 9 N/A Leadership 1 2 3 4 5 6 7 8 9 N/A Interpersonal Skills 1 2 3 4 5 6 7 8 9 N/A Openness 1 2 3 4 5 6 7 8 9 N/A Empathy 1 2 3 4 5 6 7 8 9 N/A Judgment 1 2 3 4 5 6 7 8 9 N/A Communication Skills 1 2 3 4 5 6 7 8 9 N/A Integrity 1 2 3 4 5 6 7 8 9 N/A Social Awareness 1 2 3 4 5 6 7 8 9 N/A Overall Personal Qualifications 1 2 3 4 5 6 7 8 9 N/A

In rating the applicant, who is your basis of comparison? Other students Other employees Other volunteers Other ______What is your overall recommendation of the candidate? Highly Recommended Recommended Recommended with Reservations Not Recommended If you have not recommended or recommended the applicant with reservations, please give a brief explanation. ______RECOMMENDER SIGNATURE DATE THANK YOU!