Combined BA/BS-MD Supplemental Application 2015

Transcription

1 Combined BA/BS-MD Supplemental Application 2015 Instructions Thank you for your interest in the University of Colorado BA/BS-MD program. Please make sure you read through to the bottom of this page before proceeding to the rest of this supplemental application. We are currently seeking qualified candidates who have a strong interest and passion in becoming primary care physicians and who will eventually practice medicine in the State of Colorado. This program is designed for Colorado high school seniors who are: From educationally disadvantaged backgrounds. From financially disadvantaged backgrounds. From federally designated rural/frontier communities in Colorado. From ethnic groups who are currently under-represented in the medical community in Colorado. From first generation families who reside in Colorado. Committed to practicing in Colorado as a primary care physician after the completion of medical school. 1. Students must meet the following minimum criteria to be eligible for this program: Students must be current permanent residents of the State of Colorado. Students must be current high school seniors and planning on graduating from high school in the Fall of 2014 or Spring of Students must have a minimum grade point average of 3.5 (weighted or unweighted, whichever is higher). Students must have a minimum CCHE index of 110 or higher. Students must apply to and be accepted for admission to the University of Colorado Denver Downtown campus. Students wishing to attend the University of Colorado Boulder, or any other college/university are not eligible for this program. 2. Incomplete applications will not be considered. Please make sure you answer all the questions in this application. If questions are left blank, your application will be considered incomplete and not evaluated for admission to this program. 3. Please make sure you have submitted all requested materials (at least 2 letters of evaluation, transcripts, and essays which are described later in this application) by the stated deadlines. If we are missing any of this material at the end of the application period, we will not be able to consider your application for this program. 4. Students must be available for in-person interviews in Denver to be considered for this program. We will not be able to accommodate phone interviews, Skype interviews or alternative dates for interviews. Click here to go to the Supplemental Application >>>

2 Combined BA/BS-MD Supplemental Application 2015 Page 1 [Note: For best results with this form, use Internet Explorer 7, Firefox 6, Safari 4, or greater. Other modern browsers may work as well. If you experience any problems completing the form or need additional information, please contact the Office of Admissions at ] Instructions: This online form consists of three separate pages and all three pages must be completed in one sitting. You CANNOT go in and out of the application to make any changes. (You may want to download this PDF version of the application to help collect all the information you need before starting the online form.) Be as complete and as accurate as possible. Click the submit button at the bottom of each page to advance to the next page. IMPORTANT: You MUST APPLY to the University of Colorado Denver before submitting the Combined BA/BS-MD Supplemental Application. In order to be considered for acceptance into the BA/BS-MD Program, you must be ADMITTED to CU Denver by December 1, When you are accepted downtown you will receive a 9-digit CU Student ID#. I. Personal Information For your "Student ID", enter your CU ID if you have one. Otherwise enter your 10-digit phone number. Just the numbers. DO NOT enter dashes or spaces. Student ID Last Name First Name Middle Name or Initial Gender Choose Street Address City State Zip County Home Phone Date of Birth (select) Jan Cell Phone Address High School High School City Primary Language Other Language

3 Have you applied to the University of Colorado Denver? (Check if Yes) Have you been accepted to the University of Colorado Denver? (Check if Yes) II. Parent/Legal Guardian Information Name of Parent Living? Highest Level of Education Current Occupation Name of Parent Living? Highest Level of Education Current Occupation III. Demographic Data Check all that apply: American Indian or Alaskan Native Asian Indian Asian Vietnamese Other Asian Black or African American Hispanic/Latino/Latina White Multi Racial Other: I am from a recognized rural community in Colorado. (Check if Yes) IV. Academic Summary High School Class Rank Un-Weighted GPA Weighted GPA Overall ACT Comp Score Overall SAT Score Submit and go to Page 2

4 Combined BA/BS-MD Supplemental Application Page 2 V. Honors and Awards Please list all honors and awards you have received in high school. [Note: Enter one honor at a time and press the SUBMIT button after each one.] Honor and/or Award Date Awarded (select) Submit Honor VI. External Experiences and Activities in Research, Clinical or Community Service Please provide us with the names of organizations where you have had expreiences related to research, clinical work or community service while in high school; your role with the organization, your dates of participation, how many hours per week you spent at this activity, and what your responsibilities were. Please indicate/describe any leadership roles you may have had. Name of Organization Your Role Start Date (select) End Date (select) Hours per Week Brief Description (limit 1500 characters) Submit Experience

5 VII. Part/Full Time Employment Experiences For each job you had while in high school, please provide the name of the organization, your job title, your dates of employment, the number of hours you worked per week, and a brief description of your job duties. Name of Organization Your Job Title Start Date (select) End Date (select) Hours per Week Brief Description (limit 1500 characters) Submit Employment.. Go to Part 3

6 Combined BA/BS-MD Supplemental Application Page 3 VIII. References Please provide the names of the two or three (no more than three) individuals providing letters of recommendation on your behalf. Please include their phone number and the organization they are associated with. References should include at least (1) one science or math teacher and (2) one letter from somebody who has supervised you in a community volunteer experience. Please make sure that the persons writing your letters specifically address your strengths, weaknesses, and general qualifications and preparation for the BA/BS-MD Program. Generic letters addressing your preparation for college in general are discouraged. Name of Reference Phone Number Organization You must have your recommenders submit their letter to the following address: Office of Student Life Mail Stop C East 19th Ave, Room 5231 Aurora, CO Attention: Andres Montelongo, Admissions, BA/BS-MD Program (303) Submit References IX. Essays Please complete the following four essays in the spaces provided. Please do not exceed the space provided (approx characters, including spaces and punctuation). 1. Please describe for the Admissions Committee how you might meet one or more of the criteria listed on the cover page for this application (From educationally disadvantaged backgrounds; From financially disadvantaged backgrounds; From federally designated rural/frontier communities in Colorado; From ethnic groups who are currently under-represented in the medical community in Colorado; From first generation families who reside in Colorado; Committed to practicing in

7 Colorado as a primary care physician after the completion of medical school.) 2. Please tell us about your experiences working in a non-compensated capacity with individuals from a disadvantaged/underserved community in Colorado. What did you learn about yourself or others working with individuals in these types of settings? 3. Please tell us why you want to attend the University of Colorado Denver and why you think the University of Colorado Denver is a good 'fit' for you with respect to your undergraduate (not medical school) education. 4. People often take different (and sometimes difficult) paths on their journey to becoming a physician. Please tell us about a hardship you have had to overcome or a challenge you have faced in arriving at this point in your life. How has this changed your perspective about your community and practicing medicine in an underserved community in Colorado? Submit Essays X. Transcripts Please have every high school or college you have attended send us official transcripts. These transcripts can be sent to the folowing address: Office of Student Life Attn: Andres Montelongo, Admissions, BA/BS-MD Program Mail Stop C292

8 13120 East 19th Ave, Room 5231 Aurora, CO We will not request your transcripts from the University of Colorado Denver Downtown Campus. Though you have submitted your transcripts to that campus you must also submit them to the School of Medicine as a part of this supplemental application. XI. Declaration To the best of my knowledge, the information submitted in this application form is accurate, true and complete. I understand that the deadline for submission of this supplemental application is October 31, 2014 and no exceptions will be made for this deadline. I further declare that I understand as part of acceptance into this program I will be required to attend the University of Colorado Denver full-time, that I will be required to live in the Campus Village student housing my first year of college, and that I will potentially be required to repeat some honors and/or AP courses I may have taken in high school if deemed appropriate by the Director and/or Program Coordinator. Lastly, I declare that I am a permanent resident of the State of Colorado at the time of this application. For the purposes of this application I affirm that my name entered into the box below represents my official handwritten signature. Signature: Date: 9/12/2014 Check here to affirm signature. Submit Declaration.. Click to finish Supplemental Application

9 Combined BA/BS-MD Supplemental Application NAME, Thank you for submitting the Supplemental Application for the BA/BS-MD Program. If you have any additional questions, please use the contact information below: Office of Student Life Attn: Andres Montelongo, BA/BS-MD Program Mail Stop C East 19th Ave, Room 5231 Aurora, CO (303) Just a reminder: You will be using the above address and phone number to contact the School of Medicine office and to submit application related materials. Please print this page by pressing this button: Print Page Please EXIT THE BROWSER now to protect your private information.