Ben-Gurion University of the Negev- faculty of Health Sciences

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Ben-Gurion University of the Negev- Faculty of Health Sciences

Medical School for International Health

2017 Application for Admission

Applicant Personal Data

Full name:                  

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 Male month day year

Last four digits of Social Security/National Identity number:      

Place of birth:                  

City State/Province Country

Legal permanent address:                              

Street Apt City/State Country Postal Code

Permanent phone number:       Email address:      

Preferred mailing address:                              

Street Apt City/State Country Postal Code

Preferred phone 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:      

Academic Information

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 #      

Total GAMSAT score:       GAMSAT ID #      

We accept MCAT scores that are no more than three years old and GAMSAT scores that are no more than two years old. To retrieve your sixteen-digit MCAT alphanumeric code, please go to, log in, and find the option to “print an official copy of my MCAT scores”, and enter that code above. To retrieve your seven-digit GAMSAT ID, please go to

If English is not your first language, please provide your TOEFL score:       Month/Year      

Have you previously applied to the Medical School for International Health?

      No      Yes, in      

Have you previously attended, or are you now attending another medical school?

     Yes      No

If yes, dates attended:       to       Number of years of completed medical study:      

I have received, or expect to receive before August 2017, the degree of      


If you hold an advanced degree, please list the school(s) and date(s) of study:

      School(s), Date(s) of study

Have you ever been suspended or placed on academic probation at any institution of higher learning?

     No       Yes If yes, indicate the date and reason:      

Have you ever been convicted of a felony?      No      Yes If yes, indicate the date and reason:      


Please type answers in WORD, and name the file “first and last name ESSAYS”.

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. (no longer than one 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? (no longer than one page, single spaced)

Prerequisite courses in progress at time of application

Applicants must have or expect to receive an undergraduate degree before entering MSIH. Coursework must include one year each of biology, one year of physics (or one semester of physics and one semester of math, preferably calculus or statistics), and two years of chemistry (with labs), one of which must be organic chemistry or biochemistry 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:      


Course Title











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?

     Yes      No

If you will not have a committee letter, please list the names of at least three people who will submit

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      Social Media

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.

Signed:       Date:      

Application checklist:

Items 1-4 may be sent via email by the applicant to

□1. Email the completed application form, with file named “first and last name APPLICATION”

□2. Email a complete CV, with file named “first and last name CV”

□3. Email a .jpeg photo, with file named “first and last name PHOTO”

□4. Email all three required essays, with file named “first and last name ESSAYS”

Items 5-6 are to be submitted independently by the letter writer or an authorized school official via third party entities like Interfolio or emailed directly on official letterhead to

□5. Submit official academic transcripts from all education after high school

□6. Submit a minimum of 3 letters of recommendation or committee letter

□7. Provide credit card information to process the $95.00 application fee. Call the NY office at 212-995-1231 to provide a credit card number. Applications will not be processed until payment is made.

Alternatively, documents can be sent 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

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