The Pforzheimer House due: April 1st Pre-Medical Application Brought to you by the Pforzheimer House Pre-Medical Advisory Committee



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The

Pforzheimer

House
DUE: April 1st


Pre-Medical Application


Brought to you by the

Pforzheimer House Pre-Medical

Advisory Committee





Application Contents

Introduction, Important Information 2

Summary Sheet 3

Quantitative Data 4

Background and Experience 5

Essay Questions 8

Additional Documentation 9

Application Planning 10


Introduction
This application has been designed by the Pforzheimer House Pre-Medical Advisory Committee in order to facilitate the composition of your House Letter and to better prepare you for medical school applications and interviews. Use it in conjunction with the Pre-Medical Handbook in order to examine your past experiences and how they have influenced your desire to become a physician.
Important People
The medical school application process is coordinated by the House Office. They organize and submit all of the paperwork for your committee letters, letters of recommendation, and schools you are applying to. Please be mindful of deadlines, kind and considerate to these hard-working people. They are your allies.
Allston Burr Assistant Dean of Harvard College, Pforzheimer House:

Brigitte Libby pforzheimerhousedean@fas.harvard.edu



Academic Coordinator: Abby Rahn pforz@fas.harvard.edu
Instructions And Deadlines
Please remember that a complete application is comprised of this form, as well as the documents requested below. Late applications will be lower on the priority list, and may affect the strength of your committee letter. All materials should be submitted to the Academic Coordinator (pforz@fas.harvard.edu).
April 1st, 5:00PM

  • Submit this form. If submitting via email, please include your name in the title of the file, preferably Last, First - PreMed App 2017




  • Submit an unofficial transcript from Harvard College. Instructions here: http://registrar.fas.harvard.edu/transcript/order-transcript




    • If you are a current undergrad, after Spring 2017 grades have been finalized you will need to submit an updated unofficial transcript.




    • Harvard Summer School courses will only appear on a transcript requested from the Division of Continuing Education. More information is available at the link above.




  • Submit copies of your MCAT/DAT/GRE scores. If you take an exam multiple times, always submit updated score reports.




  • Submit the GPA excel worksheet (see page 4).




  • Submit the Dean’s Letter Release Form (see page 9).


May 1st, 5:00PM


  • Double-check that your letters of recommendation have arrived in the House Office.



Summary Sheet

Identifying Information





Name: Last, First Middle

Harvard ID #:       AMCAS #:      

Preferred Email:      

(If current student) Pfoho Mail Box #:      

Permanent Phone:      




Permanent Address:      

State being claimed as Legal Residence:      

City:       State:       Zip Code:      

Age:      




Are you a US citizen?

If no, please indicate country of citizenship:      

How do you describe your ethnicity/race/background? Please be as specific as you like (e.g. Asian, Black, Hispanic, multiracial, etc.)      

Date of Birth:

Place of Birth:      




Concentration(s):      

Secondary:      

Foreign Language Citation:      

Honors? Thesis?

Date of Graduation:

Degree(s):      







Summer Address and Phone

(If different than the above.)



Summer Contact

(List a person who will be able to reach you at any point during the summer.)



Address:      


Name:      

Relationship:      



Phone:      

Phone:      

Email:      

Email:      



Application Data


Please indicate below the types of programs to which you will be applying. Check any that apply:

MD only

MD/PhD

MD/MPH

Dental

DVM


Quantitative Data

AMCAS requires you to complete an Academic Record Sheet (their own version of a transcript) and strongly suggests that you use their GPA calculation format to determine your own AMCAS GPA. We require this information for your House letter. Visit http://pfoho.harvard.edu/files/pfoho/files/gpa_worksheet_0.xlsx to complete the GPA worksheet/AMCAS GPA calculations sheet. The worksheet does not need to be typed, but it does need to be completed in its entirety, re-checked, and submitted to the Academic Coordinator (pforz@fas.harvard.edu or in-person). THIS IS REQUIRED IN ADDITION TO THE SUBMISSION OF AN UNOFFICAL TRANSCRIPT. Transfer all requested values to the respective question below.


The completion of this section will be tedious and time consuming, yet, once accomplished, you can transfer your answers directly to the actual AMCAS form. Remember that you must include any college level courses taken in high school or while an undergraduate (including summer classes and courses at other schools). Additional suggestions regarding this section can be found in the AMCAS section of the Pforzheimer House Pre-Medical Handbook as well as at www.aamc.org. Please refer to the AMCAS application at aamc.org for complete details regarding grade reporting.
Grade Point Averages





Science

GPA

Non-Science

GPA

Overall

GPA

Freshman Year

     

     

     

Sophomore Year

     

     

     

Junior Year

     

     

     

Senior Year

     

     

     

Overall Undergrad

     

     

     

Graduate Courses

     

     

     

Post-Bacc Courses

     

     

     

Overall

     

     

     



MCAT Scores



Have you taken the MCAT?



If no, when do you plan to take it?



























Date

Total

CARS

Physical

Bio

Behave

First Time Taken



     

     

     

     

     

Second Time Taken



     

     

     

     

     

DO NOT FORGET TO ALSO SUBMIT THE SCORE REPORT(S).



Background and Experience




Family








Guardian #1

Guardian #2

Name:

     

     

Relation:

     

     

Occupation:

     

     

Employer:

     

     

Education:

     

     

Siblings (age and gender):      

Relatives in Medicine:      


Research / Clinical Experience





Research Experience

Where

Hrs/Wk

Freshman Year:

     

     

Freshman Summer:

     

     

Sophomore Year:

     

     

Sophomore Summer:

     

     

Junior Year:

     

     

Junior Summer:

     

     

Senior Year:

     

     

Post-Grad:

     

     


Clinical Experience

Where

Hrs/Wk

Freshman Year:

     

     

Freshman Summer:

     

     

Sophomore Year:

     

     

Sophomore Summer:

     

     

Junior Year:

     

     

Junior Summer:

     

     

Senior Year:

     

     

Post-Grad:

     

     


Undergraduate Experiences


When did you matriculate at Harvard?: .

Harvard Acceptance Status:

List any other universities attended and dates:      

Current Harvard concentration(s):      

Previous concentration(s) and switch dates:      

Are you an Honors candidate?
1. List any academic honors and/or prizes you have received while in college. Include brief descriptions where appropriate.

     
2. If you will write an honors thesis, please name your advisor, give the title of your thesis, and summarize your topic below.

     
3. List any extracurricular activities with which you were involved. Include names, dates, time commitment/week, brief descriptions, and offices held where appropriate.

     
4. List your college work experiences. Include dates, hours and brief description of duties.

     
5. List any research experiences in which you have been involved (need not be basic science research). Include institution, lab, dates, brief descriptions and responsibilities.

     
6. List any clinical experiences you have had. Include institution(s), dates, brief description and list of responsibilities/skills.

     
7. How have you spent your college summers. Please list chronologically and be brief if the activity has already been mentioned.

     
8. List any other sports, house activities, and other extra-curricular activities and/or hobbies not yet mentioned with which you have been involved while in college (or after graduation).

     
9. List any special skills (languages, artistic talents, music abilities, computer skills, etc.) that you would like us to know about (include awards or distinctions received).

     
10. If you have taken a leave of absence during college please briefly explain why. List the dates involved, reason for leave, and how you spent your time.

     
11. If you have been placed on discplinary probation or required to withdraw, list the action, consequences, and give a brief explanation below. (Admonishment by the Ad Board and Dean's Warnings are not reportable.)

     
12. If you are a Pforzheimer House alum (or graduating senior), please list your date of graduation and explain how you have spent (will spend) your time since (after) graduation.

     


High School Information

High School Name(s), location(s) and graduation date:      

List any special attributes of your high school (science prep, Governor’, music, boarding, etc.):      

High school GPA on 4.0 scale (include whether you were valedictorian or salutatorian):      

High school class rank (include total number in graduating class):      
1. Briefly list any significant high school academic achievements and awards. Include a brief description where appropriate.

     
2. Briefly list any significant high school activities and organizations (include offices held, length of time involved and a brief description where appropriate):

     
3. List any significant high school work experiences (include number of years and hours/week):

     

Essay Questions
Many of these questions will be useful to you (and perhaps repeated) in your applications and interviews, and will serve to help your premedical advisor write your house letter. Please take time in completing them and type your response. (2-3 paragraphs each)
1. Why did you select your concentration? How do you expect it to contribute to your future development as a physician?

     


2. What have been the strengths and weaknesses of your academic performance in college? What have you done to improve any weaknesses in your academic record that may be mentioned by a medical school admissions officer? Please provide clarification and describe how you rectified the situation.

     
3. Given that there are any number of careers for people who "like science" and "want to help others", how do you know that medicine is the right career choice for you?

     
4. What careers other than medicine have you considered? Why have you chosen not to pursue these careers?

     
5. Please relate a specific clinical experience that affected you in your decision to join the medical profession.

     
6. If you feel that a personal hardship has significantly affected your life, your career choices, or your academic performance please explain the situation.

     
7. If you feel that your gender, orientation, religion, or race has posed a specific challenge to you in your personal or academic development, please describe this challenge and any steps you have taken to overcome it.

     
8. What are your plans for the future, 10-15 years down the road? How will you contribute to the field of medicine?

     

Additional Documentation


Dean’s Letter Release

Per Harvard College policy, in order for the Allston Burr Assistant Dean of Harvard College for your House, as well as your Premed Advisor and Resident PreMed Tutors to have access to your educational records in order to compile your House Letter, the Request for a Dean’s Letter waiver must be completed. This form can be found online (http://pfoho.harvard.edu/files/pfoho/files/deans_letter_waiver_july_16_rev.pdf.pdf) as well as outside the Academic Coordinator's office, and must be completed by the applicant and submitted along with this Pfoho Premed Application by April 1st.



Letters of Recommendation

After you have submitted this form the Academic Coordinator will contact you with a list of recommendations you already have on file. You will be asked to select which recommenders' letters you wish to be submitted as part of your application by August 10.


If you are MD candidate you should select 3-5 letters of recommendation for submission, and 4-6 for MD/PhD cadidates. The maximum letters that can be submitted per applicant through our process is 6 letters, although other letters on file can be used to write your committee letter. The waiver form to be given to your recommenders when you ask them to write you a recommendation can be found online (http://pfoho.harvard.edu/files/pfoho/files/LOR_waiver_7.16_rev.pdf) as well as outside the Academic Coordinator's office. It is your responsibility to make sure that all requested letters of recommendation are accompanied by a waiver form, otherwise they cannot be used in your House letter! Letters of recommendation are guaranteed to be included in your House letter if they arrive at the Pforzheimer House Office by May 1st. If received later than this date, they will be submitted to medical schools, but we cannot guarantee that they will be included in your House letter.
Remember to ask all of your recommenders if they can write you a strong letter of recommendation, and provide them with as much information as possible about your application, i.e. a cover letter, your resume, and a copy of your AMCAS essay. Be sure to talk to them about why you want to go to medical school. Also, remember to write thank you notes! Please refer to your Pfoho PreMed Handbook for further advice regarding letters of recommendation.


Application planning
List 4-6 recommders who you have asked/plan to ask for letters of recommendation:


Name:      

Title:      

Relationship:      

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Name:      

Title:      

Relationship:      

Name:      

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Relationship:      

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