First Middle Name (if no middle name, please indicate “no middle name”) Last
Please include your full legal name: first, middle and last. If you do not have a middle name, please indicate “no middle name”. Please note: this is how your name will appear on your transcript, diploma and all other university documents.
Birth date: / /
Female Malemonth day year
Last four digits of Social Security/National Identity number:
Single Married Number of children: none one two +
Citizenship(s): (List every country of citizenship):
Passport number(s): Issuing Country(s):
Father’s name, citizenship and occupation:
Mother’s name, citizenship and occupation:
High school attended: State/Country
If you did not attend college immediately after high school, or if there was more than a six-month break in your studies, briefly state the reasons.
Undergraduate college/university: State/Country
Dates attended: to Degree: Major:
GPA: Science GPA: Class rank/standing (if available):
Total MCAT score: MCAT verification code: AAMC ID #
We accept MCAT scores that are no more than three years old. To retrieve your sixteen-digit alphanumeric code, please go to aamc.org/mcat, log in, and find the option to “print an official copy of my MCAT scores”, and enter that code above.
1. Please describe your education, skills, and/or experiences that are relevant to global health.
(no longer than one page, single spaced)
2. Please provide a biographical essay describing yourself. (3/4 page, single spaced)
3. What is the biggest challenge that you have faced to date? How did you handle it? In retrospect, what would you or could you have done differently? (3/4 page, single spaced)
Prerequisite courses in progress at time of application
Applicants must have or expect to receive an undergraduate degree before entering MSIH. Your coursework must include one year of biology, one year of physics, and two years of chemistry, one of which must be organic chemistry with labs and lectures.
Please list the courses that you are currently taking or will complete before matriculation that are required for admission. You must supply transcripts for all coursework.
Academic Year 20 to 20 College/University attended:
Recommendations and Committee Letter
Does your college/university have a pre-medical committee? Yes No
Have you requested a recommendation from your college pre-medical committee or advisor?
recommendations (you may submit additional recommendations if desired):
1. 2. 3.
How did you hear about us?
Website Pre-health Advisor Professor MSIH Alumni/Student
E-news Blog Campus visit Conference Ad
News article Brochure Facebook
Application signature, fee and submission process
The admission and registration of the undersigned, if granted pursuant to this application, is subject to all rules and provisions set forth by the university. I hereby certify that all information provided in my application is truthful, accurate, and complete.
1. Complete the application and submit via email to email@example.com
2. Email a complete CV, with file name “your first and last name CV”
3. Email a photo, file name with your “first and last name PHOTO”
4. Call the office at 212-995-1231 to provide a debit or credit card number for the $95.00 application fee. Your application will not be processed until the fee is paid.
We accept transcripts and letters of recommendation sent to us via email from third party entities like Interfolio. Please have transcripts and letters of recommendation sent via email to firstname.lastname@example.org or by US Mail or overnight courier to:
Medical School for International Health
601 West 168th street, Suite 63
New York, NY 10032
Questions about the application process?
Please call the office at 212-995-1231 or email us at email@example.com