Joan and Sanford I

STUDENT NATIONAL MEDICAL ASSOCIATION HEALTH PROFESSIONS RECRUITMENT AND EXPOSURE PROGRAM (HPREP) 2016

Instruction Sheet

Established in 1973, the Sophie Davis School of Biomedical Education is a unique program subdivided into the Biomedical and the Physician Assistant program. Founded at City College, this program provides aspiring New York high school seniors and admitted freshmen college (potential transfer) students with the opportunity to fulfill the school's mission “...to recruit underrepresented minorities into medicine, increase medical services in historically underserved areas, and increase the availability of primary care physicians.” Partnered with the Student National Medical Association (SNMA), Sophie Davis is searching for motivated underrepresented minority high school students who are interested in the sciences to participate in the 2016 HPREP program. HPREP has been recognized as a nationwide effort to encourage minority students to consider a career in the fields of science and medicine. Founded at Weill Cornell Medical College in the late 80s, HPREP now exists at universities throughout the country and has finally to Harlem! For the Fall of 2016, HPREP at Sophie Davis will provide eight (8) sessions held on Friday afternoons during the months of October & November. Students will be expected to arrive at City College at the designated time and will be instructed by guest speakers, community physicians, and Sophie Davis faculty, who will prepare and present many of the live presentations. Post seminar, students will participate in small group workshops led by Sophie Davis medical students where they will review material from the lecture, revise and develop their college essay, and engage in problem-based- learning activities. With the guidance of our medical students, all participants will be expected to submit two written assignments by the end of the program. All students will be granted an exclusive opportunity to visit the gross anatomy lab and two participants will receive a prize (to be announced) in recognition for their outstanding work. And let's not forget, this experience is a wonderful additive to any resume!

To apply the following items must be submitted in a timely manner: • A completed application form • An official copy of the student’s transcript • Two 250-500 word essays typed in Times New Roman (or equivalent) 12-point font Topic 1: An essay answering these questions: Why are you applying to HPREP? What are your future goals and how do you think HPREP will help you in your future endeavors? AND Topic 2: An essay about ONE of the following: 1) Evaluate a significant experience, achievement, risk, or ethical dilemma you have faced and its impact on you. 2) Discuss an issue of personal, local, national, or international concern and its importance to you. 3) Indicate a person who has had a significant influence on you, and describe that influence. 4) Describe an encounter that demonstrated the importance of diversity to you.

• Submission of one letter of recommendation from a science teacher, guidance counselor, a non-science teacher, a supervisor of a community service, volunteer organization in which you are a member, a community leader, OR an employer, is STRONGLY URGED.

THESE ITEMS MUST BE POSTMARKED NO LATER THAN SEPTEMBER 19th 2016 IN ORDER TO BE CONSIDERED FOR THE 2016 HPREP PROGRAM Please send all items to: The Sophie Davis School of Biomedical Education Office of Student Affairs 160 Convent Avenue, Harris Hall Room 113 New York, NY 10031 Attn.: Leonie Peele (All students will be notified of their acceptance status in a one-week notice). Please turn over for application form  Student National Medical Association Sophie Davis School of Biomedical Education Health Professions Recruitment and Exposure Program 2016 APPLICATION FORM

Please type or print legibly in black or blue ink. STUDENT INFORMATION Last Name First Name Middle Initial DOB (mm/dd/yyyy) Grade Sex Age [ ] 9th [ ] M [ ] 10th [ ] F [ ] 11th [ ] 12th Home Address (Include APT number) City, State Zip Code (Area Code) Phone Number

How would you describe yourself? Email Address [ ] Black / African American [ ] Other Hispanic (please specify) [ ] Mainland Puerto Rican [ ] Other (please specify) [ ] Mexican American ______What is your native language? [ ] Native American [ ] West Indian SCHOOL INFORMATION School Name (Please Print the Official Name)

School Address City, State Zip Code School Phone Number

Honors received during high school:

Describe your involvement in extracurricular, community, or school activities:

If you are employed while in school, please describe the type of work and the approximate hours you work per week.

FUTURE PLANS / GOALS What do you plan to do after you finish high school? [ ] Attend College [ ] Work [ ] Undecided [ ] Other (please specify) ______

ESSAYS Write two 250 – 500 word essays, one essay on EACH topic listed below. All essays must be typed and enclosed with the application. Put your name on your essays. Topic 1: In essay format, answer the following questions: Why are you applying to HPREP? What are your future goals and how do you think HPREP will help you in your future endeavors? AND Topic 2: See Instruction Sheet for topics DECLARATION TO APPLICANT: Please read carefully and sign this statement. I declare that the information contained in this application is correct and complete to the best of my knowledge and belief. I understand that any false information given will disqualify me from participation in the program. Also, I am aware that I must submit an official copy of my school transcript, two essays and one letters of recommendation that meets the requirements listed on the instruction sheet (please see reverse side). I understand that attendance is required for at least seven (7) of the eight (8) sessions, beginning at 4:30 P.M., in order to complete the program.

Applicant Signature______Date______

TO PARENT OR LEGAL GUARDIAN: Please read carefully and sign this statement.

I, ______grant my permission for the above named minor to apply to the HPREP Program, which consists of eight (8) Friday sessions from 4:30-6:45PM. I understand attendance is required for all sessions in order to complete the program, should he/she be accepted.

Guardian Signature______Date______