ࡱ> KNJ bjbj NLL0000$T0tppppp333giiiiii,d"3"333pp3Rppg3g:?,[^k S0u.""333333"333333333L :   WESTMONT COLLEGE Statement of Intention of Application to Medical School This statement is a reminder of information you will need, and a means to ensure that your premedical committee letter properly represents you in your candidacy for medical school. All the information requested must be submitted to Dr. Kristi Cantrell in the Chemistry Department. This particular document remains at app (it will not be sent with your file to medical colleges), and thus you may fill it out by hand (legibly!). There are three app forms to be completed at the time you begin your medical school applications. 1. This form indicates your intent to apply to medical school, and provides us with some general information to best represent you to the Admissions Committees. 2. The Composite Letter of Evaluation form is where you officially choose the members of your committee and waive your rights of access to this letter. This form should be typed, as it is included with the composite letter mailed to the medical school admissions committees. 3. The Committee Member Evaluation form is the one that you need to provide to each member of your committee (filling out the top portion). If you have any questions, please let me know (dept: x6152, office: x6175, email: klazar@westmont.edu). I hereby declare my candidacy for medical school, and request the services of the app premedical program. I have read the information provided here and on the Premedical web pages (http://www.westmont.edu/_academics/prehealth/). I agree to release to Dr. Cantrell any disciplinary actions given to me while at app and to allow her to report grades and class rank in the Committee Letter. _______________________________________ _______________ (signature) (date) Name (please print): Major(s) (indicate BA/BS; and track) & Graduation year: Academic Advisor(s) (& Research Advisor, if any): Honors and awards granted while at app (including Dean's List), and dates: Activities/involvements (include research, sports, clubs, leadership roles, volunteer, etc): MCAT scores and test date (if more than one, please indicate all): phys sci: ____ analysis/reasoning: ____ biol sci: ____ psych/soc: ____ mo/year: _____ Any future MCAT planned? ___________mo/yr. Contact Address (through Summer and Fall): address: phone: email: Provide the committee members you have chosen and their relationship to you. This list must include at least 2 Biology, Chemistry, Mathematics, Neuropsychology, or Physics Departments professors and one professor not from these departments, in addition to a medical professional reference. You must have no fewer than four members and should have no more than six. As premedical advisor, Dr. Cantrell is the ex officio chair of each committee. You may order the names in any way you choose, but do indicate the courses you have had with each person, and if they have directed you in research. Committee member course title/number (research?) Dr. Cantrell Chair of Committee 1. ________________________________ _________________________ 2. ________________________________ _________________________ 3. ________________________________ _________________________ 4. ________________________________ _________________________ 5. ________________________________ _________________________ 6. ________________________________ _________________________ Please return it to Dr. Cantrell, Chemistry Dept., along with the following: Please arrange for a copy of your transcript to be sent to Dr. Cantrell after Spring Semester grades are posted. You will also need to send official transcripts to AMCAS and any non-AMCAS schools to which you are applying. If you have not taken the MCAT, arrange for your scores to be sent directly to Dr. Cantrell. There is a check-off box in the registration for release of your scores to the pre-med advisor. Be sure to check this. Please provide each committee member and Dr. Cantrell with a rsum of your activities, interests, and motivation for medicine (personal statement). Please send Dr. Cantrell, by email, a copy of your verified AMCAS and/or AACOMAS applications as a pdf file. Please provide the names of the schools to which you are applying. Once you have submitted your AMCAS, and it has been verified, and all of the required documents have been received, your letters file will be uploaded directly to AMCAS or AACOMAS. After all items are received, please allow at least 3 weeks for the committee letter to be completed and then uploaded. Heidi Henes-Van Bergen, in the chemistry department, will maintain your file on campus. Please contact her if you have any questions. Your letter file will be kept for 3 years after which time it will be destroyed. (+JK8 ? 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