John L. LeFlore Magnet High School Healthcare Science/ Pre-Med Application Packet Includes: Application Form Essay Form Authorization/ Agreement Form 3 Recommendation Forms For more information, contact: Phone: 251.221.3128 FAX: 251.221.3142 Completed Application Packets are Due _ by the last date of 1 st and 3 rd Quarter _ Healthcare Science/Pre-Med
APPLICATION FORM APPLICANT: (Please PRINT legibly or type.) Applicant s Name Date of Birth Age Grade Parent s Name(s) Address Telephone _(Home) (Work) (Cell) 1. Why are you interested in becoming a part of the Healthcare Science/Pre-Med program at? 2. Do you like to work along or with other people? Why? 3. Describe any experience you have had that will be helpful to you as a student in the Healthcare Science/Pre-Med Program. 4. Describe something you do very well. (sports, school, music, cooking, etc.) 5. What do you like to do in your spare time?
ESSAY Instructions: Please PRINT in black or blue ink only. (Essay consists of three paragraphs) Paragraph one: Must be an introduction of who student is. Paragraph two: Why choose a career in healthcare? Paragraph three: What kind of student I can expect you to be?
GPA AUTHORIZATION: Please have a guidance counselor or guidance department staff member sign to verify your current GPA. GPA Guidance Signature Date ADMINISTRATOR SIGNATURE: Please have administrator signature that student is clear of ALL discipline referrals. Administrator Signature Date CLINICALS AGREEMENT: I understand that if I am accepted into this program and meet all prerequisites, I much adhere to all of the rules and guidelines of the Healthcare Science/Pre-Med Program. (Signature of Applicant) PARENT AGREEMENT: I have read this application and accompanying information, and approve of my child s participation in this educational program if he/she is selected. (Signature of Parent/Guardian) FOR MORE INFORMATION:
RECOMMENDATION FORM This form should be completely by current school principal, guidance counselor or teacher. The person completing the form may not be a relative. Student s Full Name Person Giving the Reference Reference Address Phone Relationship to Applicant Would you recommend this individual to be a part of the Healthcare Science/Pre-Med Program at? Yes No Please describe the applicant s interpersonal relationship skills how do they get along with people? Rate the following qualities with: A (Excellent) B (Satisfactory) C (Needs Attention) Attitude Dependability Appearance Is there additional information that you would like to share about the applicant? DATE SIGNATURE On behalf of the and the student who gave you this form, thank you for taking the time to evaluate this student in light of his or her success potential in the field of Health Science Please return to:
RECOMMENDATION FORM This form should be completely by current school principal, guidance counselor or teacher. The person completing the form may not be a relative. Student s Full Name Person Giving the Reference Reference address Phone Relationship to Applicant Would you recommend this individual to be a part of the Healthcare Science/Pre-Med Program at? Yes No Please describe the applicant s interpersonal relationship skills how do they get along with people? Rate the following qualities with: A (Excellent) B (Satisfactory) C (Needs Attention) Attitude Dependability Appearance Is there additional information that you would like to share about the applicant? DATE SIGNATURE On behalf of the and the student who gave you this form, thank you for taking the time to evaluate this student in light of his or her success potential in the field of Health Science Please return to:
RECOMMENDATION FORM This form should be completely by current school principal, guidance counselor or teacher. The person completing the form may not be a relative. Student s Full Name Person Giving the Reference Reference Address Phone Relationship to Applicant Would you recommend this individual to be a part of the Healthcare Science/Pre-Med Program at? Yes No Please describe the applicant s interpersonal relationship skills how do they get along with people? Rate the following qualities with: A (Excellent) B (Satisfactory) C (Needs Attention) Attitude Dependability Appearance Is there additional information that you would like to share about the applicant? DATE SIGNATURE On behalf of the and the student who gave you this form, thank you for taking the time to evaluate this student in light of his or her success potential in the field of Health Science Please return to: