ATTENTION

All applicants to the 2014 entering class (Medical, Dental, Podiatric, and Chiropractic) Please be aware of the following RECOMMENDED Applicant Seminar offered regarding the completion of the Pre-Application Materials packet which immediately follows this announcement. You are asked to contact the Pre-Health Professions Advisement Office for the official time and to sign up for this seminar: Time and Location: Friday, Feb. 22nd from 1:30 to 3:30pm in HPA 1, Rm. 116 A note about eligibility: If you are applying to an allopathic medical school (granting the M.D. degree) you will need a minimum Overall GPA of 3.40 or better to qualify for the complete Composite Evaluation packet service. A minimum Overall GPA of 3.30 will be required of students applying to all other professions. You can petition to appeal the GPA requirement if your academic performance has been significantly above the minimum GPA requirements during a sustained period of time (four semesters) prior to application or use the Letters Only service. PLEASE NOTE: The PHPAO advises UCF applicants to Optometry, Pharmacy, Veterinary Medicine, or Physician Assistant schools to process their applications independently of our office as the national application services for these professions severely limit the benefit of our Composite Evaluation Packet to the students. For all other applications preferred completion/turn-in dates are as follows: Deadline for full Composite Evaluation Packet: May 15, 2013 (All supported professions) LETTERS ONLY Support Deadline August 15, 2013

Composite Evaluation packets are mailed out to national application service organizations in the chronological order of completion of the Pre-Application Materials packets, so it will behoove you to turn in your completed materials to our office as soon as possible after the February availability date. If you have any questions or concerns about our support service, please contact the office at (407) 823-2670. Providing the office with a copy of your national application and national test scores is highly recommended!

CONFIDENTIAL PERSONAL DATA FORM

University of Central Florida Pre-Health Professions Advisement Office
PLEASE RESPOND TO THE QUESTIONS ON THE FOLLOWING PAGES WITH CARE AND DELIBERATION

Name: Last First Middle Pre-Professional Area: Pre- ----Major: -Academic Advisor: Class: ----Telephone: ( ) ( ) Local Permanent Local Address: City: State: Zip Code: Permanent Address: City: State: Zip Code: Date of Birth: Present Age: Legal Residence: Citizenship: State Country The following is optional High School Attended: City: Yr of Grad: Class Size: Rank: Your Marital Status: ----Father Status Mother Status

Please bring a passport-style photograph to be attached by the PHPAO Staff

State:

---

---

---

Spouse Status

Name: Occupation: State of Residence: Education/Degrees: Institution Siblings: --- ----- ----- ----- --Name Age Siblings: --- ----- ----- ----- --Name Age

Children: -----------------

Name

Age

Children: -----------------

Name

Age

List in reverse chronological order every college or university attended:

Name of College or University Type of Degree ------------------------Academic Major Dates Attended From To Present Year to be Graduated

1.

Has your education been continuous other than for vacation? Yes No if not, or if not in college, indicate what you have done while out of school or since graduation. Please include pertinent dates for each activity, including the names of the organizations you have been associated with and the types of duties you are engaged in. Begin with the most recent one.

2.

List college extracurricular activities (include offices held). Please note that extracurricular activities should include health-related volunteer/paid clinical exposure, research, and community service. Please include, beginning with the most recent one, pertinent dates for each activity, location where it took place, and the specific nature of each activity. Add the name of your mentor/supervisor when applicable (research, shadowing, etc.)

3.

List hobbies, fun, and diversion interests not accounted for in question 2.

4.

List, beginning with the most recent one, honors and special awards received. Please include pertinent dates for each.

5. Have you been employed during the academic year while in college? Yes recent one.
Academic year ---------------Type of Work From To Hrs/Wk

No

Start with the most

6.

Have you held summer jobs between academic years? Yes dates, beginning with the most recent one.

No

if yes, give type of work and list

7. 8.

Approximately what percentage of your college education has been financed through your own incomegenerating activity? ---Have you ever worked/volunteered in a health-care delivery environment? Yes No if yes, describe and include pertinent dates for each activity and the nature of the activity you performed, beginning with the most recent one.

9.

What specific factors have triggered your motivation toward the profession you have selected as a career? Please limit your narrative to the space provided below. The limit for Dental applicants is 4500 characters, MD applicants is 5300 characters, and for DO applicants is 300 words. Be as concise as possible.

__________________________________________________ Signature

_____________________ Date

WAIVER/NON-WAIVER FORM

I understand, in compliance with The Family Educational Rights and Privacy Act of 1974, that all information gathered and assembled in my pre-applicant file may be shared only with those individuals or institutions designated in writing by me. Furthermore, by my signature below, I validate my personal choice regarding my right of access to all information contained in my applicant file.

I wish to --WAIVE my right of access.

________________________________ Signature

_____________________ Date

REQUEST FOR SUPPORTING DOCUMENTATION

Instructions: Individuals from whom reference letters are to be solicited must have full name, building and office number (oncampus) or full address (off-campus). Science faculty (2) Include full name, address and course prefix, number, title and term.

1. Name Address (or email) Course(s)

Term(s)

2. Name Address (or email) Course(s)

Term(s)

Non-science faculty (1) Include full name, address and course prefix, number, title and term.

1. Name Address (or email) Course(s)

Term(s)

Other (2) Include full name, title and complete mailing address. Examples of referees in this category include an employer, health care practitioner, research supervisor, or any other individual who can provide evidence about your character.

1. Name Address (or email)

2. Name Address (or email)

LIST OF SCHOOLS
List institutions to which supporting documentation is to be sent. Please specify EXACT institution name. Check this box if you are applying EARLY DECISION to one of the schools listed above. Also check the box next to the number of the selected Early Decision institution.

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24.

25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50.

WORK/EXTRACURRICULAR EXPERIENCE (Omit this section IF you are using the PHPAO for the LETTERS ONLY service.)
For: Pre- --- --PID# Major

In the box provided below, please list 2-3 experiences youve had in each category, making sure to include timeframes (i.e. 5/10 through 10/10) and approximate hours per week spent participating in each event. We realize this information may be provided elsewhere in this Pre-Application Materials packet in more detail, but for this section, please limit your entries to those most relevant. (Include dates/hrs. per week) Work:

Volunteer:

Extracurricular:

Research:

PLEASE PRINT: First Middle Last Preferred or Nickname: (if other than above) ____________________________ PID #: _____________________________ E-Mail Address: _______________________________________ The following information is REQUIRED of all applicants, although it may be later in the process: 1) Application Service ID#: AMCAS: AACOMAS: AADSAS: OTHER: 2) __________________Letter ID#_______________ _____________________________ _____________________________ _____________________________ Name:

Your OFFICIAL transcript(s) from every college youve attended? Submitted at turn-in: Yes No If not, have you ordered it/them? Yes No Your Autobiography Word document must be included at turn-in time, AS WELL AS e-mailed to Cary.Pellizzeri@ucf.edu? Have you done both? Yes No Are you enrolled in Summer 2013 courses? Yes No

3)

4) 5)

Have you taken your appropriate admission test? Yes No If no, when DO you plan to take it? ________________ If yes, when DID you take it? ________________ Do you plan to retake it? If so, when? ___________