Kutztown university of pennsylvania



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KUTZTOWN UNIVERSITY OF PENNSYLVANIA
Official use only
Date Received:


HEALTH PROFESSIONS CANDIDATE

Intent to Apply Form


Deadline: Nov 1st 2015, to be considered for the 2016 applicant pool

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.


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List the schools/programs you intend to apply


  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.




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






  1. 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).



  1. 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.

Return a hard copy of this completed form, in person, to
Dr. Matthew D. Stone

Co-Chair, Pre-professional Health Careers Committee



Kutztown University



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