Biographical form



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Tarleton Health Professions Advisory Committee (HPAC)

Name:      

BIOGRAPHICAL FORM

Date: 11/2/201610/18/2010

All forms must be typed.

To complete Section XVI, you will need an official or unofficial transcript from each college you attended.


Sections 1-3 are for the HPAC. Keeping the HPAC apprised of changes to this information will prevent delays in your evaluation process.

I. BACKGROUND INFORMATION
TSU student ID#:       telephone #:       e-mail:      

If your are Pre-Med, -Dent, or -Vet and have registered with TMDSAS, what is you TMDSAS #:      

From what high school did you graduate (include city and state)?      

What was your rank in your high school graduating class?      

What was your score on college entrance exams? SAT       ACT      
When was your first semester at TSU?      

Are you a degree-seeking student at TSU?

If yes, what is your major?       What is your concentration?      

If a degree seeking student, in which semester and year do you expect to graduate?      

What is your current GPA?       Science GPA (BIOL, CHEM, PHYS, MATH)?      

How many hours did you complete in the semester of your heaviest course load?      


Professional program to which you are applying: If other, please specifiy:      

I am applying to enter professional school in the fall of 20     .

Have you previously applied to professional school? If yes, when?      
Native language English? Other fluent languages:      

U.S. citizen? If no, country of citizenship:      

Ethnicity:
Have you completed a professional school admissions test? Which exam?

If yes, when did you take this exam?       If no, when do you plan to take it?      


If you completed a professional school admissions test, please enter your scores in the appropriate boxes below.

  • MCAT: verbal reasoning       physical sciences       biological sciences       writing      




  • DAT: AC AVG     PAT      QRT     RC     BIOL      GEN CHEM     ORG CHEM     TOTSCI     




  • PCAT: VERB       RCT       BIOL       CHEM       MATH       TOT       %TOT      




  • GRE: QUANT       VER       TOT      

Briefly describe how you prepared for or are planning to prepare for your professional school admission test.



     
II. COLLEGES, UNIVERSITIES, and PROFESSIONAL SCHOOLS

Indicate in all colleges/universities you have attended as well as applicable dates of attendance:




College

(Begin with the earliest)



Dates Attended

From To

Degree Earned

(if yes, give date)



Major
(if applicable)

     

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III. YOUR EVALUATORS (NOTE: This section not currently required, but would be helpful.)

Participants must solicit 3-5 letters of evaluation, including two from Tarleton professors.




Evaluator Name

Position

Relation to You

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     



Sections IV-XIII mimic the TMDSAS application. Fill in each section thoroughly, but try to conserve words. Refer to the sample document for examples and detailed instructions.
IV. ACADEMIC RECOGNITION

Describe any academic honors, awards, and other recognitions received since beginning college to the present.



Activity/Honor

Description of Activity/Honor

Date Awarded

     

     

    

     

     

    

     

     

    

     

     

    

     

     

    

     

     

    

     

     

    

     

     

    

     

     

    

     

     

    

     

     

    

     

     

    

     

     

    

     

     

    

     

     

    



V. LEADERSHIP EXPERIENCE

Describe any leadership roles or positions of responsibility held since beginning college to the present.




Role Title


Description of Responsibilities
(including “hours/week” and “hours total”)


Dates

From To

     

     

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VI. RESEARCH EXPERIENCE

Describe any significant research activities you have participated in since beginning college.




Role Title
(include your responsibilities, “hours/week” and “hours total”)


Supervisor

Dates

From To

     

     

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VII. HEALTHCARE RELATED EXPERIENCES

Any activity in which you worked with or observed patients or health professionals is “health care related.”

Describe any such experiences that you participated in since beginning college.


Activity


Description

(including “hours/week” and “hours total”)

Dates

From To

     

     

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VIII. COMMUNITY SERVICE

Describe any non-healthcare related community service or volunteer experience that you participated in since you began college.




Activity


Description

(including “hours/week” and “hours total”)

Dates

From To

     

     

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IX. EXTRACURRICULAR/LEISURE ACTIVITIES

Describe any extracurricular or leisure time activities to which you devoted significant time since you began college.




Activity


Description

(including “hours/week” and “hours total”)

Dates

From To

     

     

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X. EMPLOYMENT EXPERIENCES

Describe any paid jobs that you have held since you began college.




Job Title

Where Employed and Responsibilities

(including “hours/week” and “hours total”)

Dates

From To

     

     

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XI. ACADEMIC DISHONESTY AND/OR CRIMINAL ACTIVITY

Describe any actions taken against you for academic dishonesty, conduct violations, criminal activity (including felony and/or misdemeanor, other than minor traffic violations). Be as brief as possible while including relevant details and applicable dates.


     

XII. PERSONAL STATEMENT/APPLICATION ESSAY - required

This question mimics the TMDSAS Personal Statement Essay.
Explain your motivation to seek a career in (field/discipline to which you are applying). Discuss your philosophy of the profession and indicate your goals relevant to the profession. Limit your response to 5000 words and attach to end of this Biographical Data Form.

XIII. UNIQUE LIFE EXPERIENCES - optional

This question mimics one of the TMDSAS Optional Essay prompts. Completing it is optional but recommended.
Briefly discuss any unique circumstances or life experiences that are relevant to your professional school application which has not been previously presented. Limit your response to 2500 words and attach to end of this Biographical Data Form.

XIV. PERSONAL CHARACTERISTICS FOR DIVERSITY - optional

This question mimics one of the TMDSAS Optional Essay prompts. Completing it is optional but recommended.

Describe any personal characteristics and/or important challenging experiences you have had that will contribute to the diversity of or provide educational benefits to your fellow students. Limit your response to 2500 words and attach at end of this Biographical Data Form.


Include your full name, word count, and the date you submit the essay—each
edited version will have a different date.


Print your essays double-spaced, in 12-point font, and submit them along with your Biographical Form.
XV. OUT OF STATE APPLICATIONS

In 2009, the following sections appeared on AMCAS (for non-Texas MD schools) but not on TMDSAS.



  • Military Service

  • Teaching or Tutoring

  • Conferences Attended

  • Presentations and Posters

  • Publications

  • Intercollegiate Activities

  • Artistic Endeavors

  • Personal Statement: “Explain why you want to go to medical school,” 5300 chars





In 2009, the following sections appeared on AACOMAS (for non-Texas DO schools) but not on TMDSAS.

  • Osteopathic Background

  • Letter from DO Recomnended

  • Personal Statement: no prompt, 4500 chars



  • In 2009, the following sections appeared on AADSAS (for non-Texas dental schools) but not on TMDSAS.

  • Personal Statement: “Discuss why you desire to enter a dentistry career and how a dental career meets your personal and professional goals.” 4500 characters”.





  • XVI. TRANSCRIPTS



  • Attach unofficial or official transcrpits to the end of this document.



  • Name:       word count:       date:      



  • Type essay prompt here.



  • Type or paste essay here.











  • Name:       word count:       date:      



  • Type essay prompt here.



  • Type or paste essay here.













  • Name:       word count:       date:      



  • Type essay prompt here.



  • Type or paste essay here.



Tarleton Health Professions Biographic Data Form

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