Kutztown university of pennsylvania

Intent to Apply Form

APPLICANT NAME:

(please print or type)
Student ID:____________________________
LOCAL ADDRESS:
PERMANENTADDRESS:
PHONE NUMBER: EMAIL:
MAJOR: EXPECTED GRADUATION DATE:
CURRENT GPA: _______ CREDITS EARNED:________ DATE YOU INTEND TO APPLY:_________
Have you taken the standardized exam (e.g. MCAT, GRE, DAT)? Y or N (circle one)
If so, list your score_________ If not, List you intended testing date________________
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Give the names of three non-committee members (and their associated department) whom you have asked to submit preliminary evaluation forms:
1.

2.

3.

1. 
   Attach a curriculum vitae (CV) or resume which contains the following information:
   

• 
  List your education background. Indicate all schools/programs attended, dates attended, degrees conferred (if applicable)
  

• 
  List all organizations, sports teams, clubs, groups, etc. to which you have belonged in college. Indicate dates, offices held, and extent of participation.
  

• 
  List any jobs (including summer employment) that you have held while a student. Indicate dates and extent of responsibility.
  

• 
  List any awards or honors received.
  

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  List volunteer work, internships, or research that you have performed that are related to your health career choice.
  

• 
  List hobbies, interests, etc.
  

2. 
   Include a well-written essay highlighting why you have chosen a particular health profession as your vocation. Your essay should be within the limits allowed by the central application system or school you intend to apply (e.g. AMCAS = 5300 characters maximum; AACOMAS = 4,500 characters max).
   

3. 
   Provide a response to the following questions:
   

• 
  If you are not accepted into the professional school of your choice, what alternative plans do you have?
  

• 
  Share any additional information about yourself that you feel is pertinent.
  

Co-Chair, Pre-professional Health Careers Committee