Health Science Pre-Professional (HSPP) Evaluation Committee

Directions:

  1. Complete the attached forms.
  2. Return the attached formsas well as copy of your personal essay* to:

Kristina Pitz

Health Science Pre-Professional Program Coordinator

.

  1. Please make sure to send your ADEA AADSAS ID to Kristina as soon as you have one.

*AADSAS instructions for the personal essay:

“The personal essay provides anopportunity for you to explain why you desire to pursue dental education. It is recommended to compose your essay in a text-only (e.g., Notepad, Microsoft Word), review your essay for errors, and cut and paste the final version into the text box. The essay is limited to approximately one page (4,500 characters,including spaces).”

Student Information Sheet

Pre-Dental

Name:
UTM ID #:
Telephone #:
E-mail:
Academic Advisor:
Year Applying:
Graduation/anticipated UTM graduation date:
ADEA AADSASID #:
Reapplicant?* / Yes / No
*If you are a reapplicant, during which application cycles did you apply?
Major(s) and minor(s) (indicate which are majors and which are minors)
Other schools attended (please list years attended/semesters attended)
Any situation which may have affected your work during any semester
Schools to which you are applying(separate by semicolons; please do not abbreviate)

Date and score of DAT(all attempts, including scheduled tests not yet taken)

Date of test
Overall score
Date of test
Overall score
Date of test
Overall score
Any other information which might be helpful in completing your evaluation

Name and e-mail of three faculty who have had you in class

Faculty name
Faculty email
Faculty name
Faculty email
Faculty name
Faculty email

Personal Essay

I would like the HSPP Coordinator to provide feedback on my personal essay.
I would not like the HSPP Coordinator to provide feedback on my personal essay.

The Family Educational Rights and Privacy Act [FERPA] of 1974 and its amendment’s guarantee students access to their education records. Students, however, are entitled to waive their right of access concerning recommendations. The following signed statement is the applicant’s wish regarding recommendations submitted by and to the Health Sciences Pre-Professional Committee.

I waive my right to inspect the contents of the recommendations.
I do not waive my right to inspect the contents of the recommendations.
Signature:

Work/Activities Overview

(adapted from the University of Memphis)

Name:
UTM ID #:

Please complete the following sections. Please make sure it is easy for the committee to differentiate between activities.Provide start and end dates for each activity, hours invested, and frequency of participation in the activity as well as the supervisor when applicable. You may group similar activities under the same title (e.g., multiple semesters on the Dean’s list or multiple summers volunteering in the same place).

Extracurricular activities (include any leadership positions you may have held)
Honors or Awards while in college
Any special academic projects, honors courses, etc.
Healthcare related experiences (work, shadowing, volunteering, etc.)
Non-healthcare work experiences
Non healthcare-related volunteer and community service experiences

Proposed Plan For Completion of Pre-Professional Courses**

** Please list all courses in which you are CURRENTLY ENROLLED and any which you are planning to take in subsequent terms.

Name:
UTM ID #:
Term:
Course # / Title
(e.g. BIOL 140) / Credits
Term:
Course # / Title / Credits
Term:
Course # / Title / Credits
Term:
Course # / Title / Credits
Have you completed all pre-professional course work?
If no, in what term do you anticipate completing the pre-professional course? (e.g. Spring 2012)