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:
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:
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 aamc.org/mcat, 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 gamsat.acer.edu.au.
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?
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:
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 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.
Items 1-4 may be sent via email by the applicant to firstname.lastname@example.org
□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 email@example.com.
□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 firstname.lastname@example.org