In working with MedSchoolCoach, you are getting a team of advisors dedicated to helping you get into medical school. You will one day join us as our colleagues in the medical field. We cannot wait for this to happen! In order for us to get to know you better, please take a few minutes and fill out this information sheet to the best of your ability.

Personal Information

Your name:

Best phone number to reach you at:

Best email address:

Preferred method of video conference (Facetime/Skype/Google Hangout):

Ethnicity:Are you a US Citizen or Permanent Resident?

State of Residence:Place of Birth:

Where did you grow up?

Do you consider yourself a ‘disadvantaged student’ (if yes, please explain)?

Do you have a specific advisor (or advisors) you’d like to request (note, we cannot guarantee an advisor as we want to assure every advisor has the time to dedicate to each student. We will evaluate who may work best with you based on your profile even if you request a specific advisor):

How did you hear about MedSchoolCoach?:

Education Information

Undergraduate Institution:

Current year in school:or Graduation Year:

Major:Minor (if applicable):

Have you completed any post graduate work (post-bacc courses, master’s degree):

Undergraduate Cumulative GPA: /4.0

Undergraduate Science GPA:/4.0

Post-bacc or graduate GPA (if applicable): / 4.0

Please include a copy or screenshot of your transcript when submitting this form so we can evaluate your grades.

Please list MCAT Scores with date taken and breakdown of scores (include percentiles as well):

Medical School Specific Information

School preference (location, state versus private, top 10 versus I just want to get in somewhere, etc):

Are you interested in applying to DO (osteopathic) schools?

Are you interested in applying to international MD schools?

Have you previously applied to medical school?

Did you receive interviews (if yes, please list schools where you interviewed)?

Activity Information

Please list any research experiences you have participated in during the last 3 years:

  1. Dates: - Approximate Hours:

Experience Name:

Publication(s), if applicable:

Comments (optional):

  1. Dates: - Approximate Hours:

Experience Name:

Publication(s), if applicable:

Comments (optional):

  1. Dates: - Approximate Hours:

Experience Name:

Publication(s), if applicable:

Comments (optional):

Please list any clinical experiences (non-physician shadowing)you have participated in the last 3 years (not including shadowing):

  1. Dates: - Approximate Hours:

Experience Name & Location:

Comments (optional):

  1. Dates: - Approximate Hours:

Experience Name & Location:

Comments (optional):

  1. Dates: - Approximate Hours:

Experience Name & Location:

Comments (optional):

Please list any physician shadowing experiences you have had?

  1. Dates: - Approximate Hours:

Physician Name: Physician Specialty:

Comments (optional):

  1. Dates: - Approximate Hours:

Physician Name: Physician Specialty:

Comments (optional):

  1. Dates: - Approximate Hours:

Physician Name: Physician Specialty:

Comments (optional):

Please list any community service experiences you have participated in the last 3 years?

  1. Dates: - Approximate Hours:

Experience Name & Location:

Comments (optional):

  1. Dates: - Approximate Hours:

Experience Name & Location:

Comments (optional):

  1. Dates: - Approximate Hours:

Experience Name & Location:

Comments (optional):

Please list any leadership activities you have participated in the last 3 years?

  1. Dates: - Approximate Hours:

Experience Name & Location:

Comments (optional):

  1. Dates: - Approximate Hours:

Experience Name & Location:

Comments (optional):

  1. Dates: - Approximate Hours:

Experience Name & Location:

Comments (optional):

Please list any academic honors or awards:

  1. Date Received:

Award Name:

  1. 2. Date Received:

Award Name:

  1. 3. Date Received:

Award Name:

Please list any hobbies/other activities:

  1. Name:

Comments (optional):

  1. Name:

Comments (optional):

  1. Name:

Comments (optional):

Please answer the following questions questions. Please provide brief or bullet pointed answers. These items can be further discussed with your advisor.

1. Why do you want to be a doctor?

2. Discuss your family and/or upbringing?

3. What do you consider your greatest strength, and your greatest weakness?

4. Have you had any life events in the last several years that have significantly changed you?

5. What distinguishes you from other medical school applicants?

6. Does your application have any ‘red flags’ (i.e. poor grades, institutional review, citations, etc)?

7. Do you have any specific questions for your advisor?