APPLICATION
LOUISIANA COLLEGE
EARLY ACCEPTANCE PROGRAM
TULANE UNIVERSITY
SCHOOL OF MEDICINE
Please type:
1. NAME:
2. PERMANENT ADDRESS: / 3. LOCAL ADDRESS:Number and Street /
Number and Street
City /
State /
Zip /
City /
State /
Zip
Telephone: ()
E-mail Address:
4. SECONDARY SCHOOL:
City /
State /
Year of Graduation
5. ALL COLLEGES AND UNIVERSITIES ATTENDED
6. IF YOUR EDUCATION TO DATE HAS NOT BEEN CONTINUOUS,
INDICATE WHAT YOU DID WHILE NOT IN SCHOOL.
7. WHAT HONORS HAVE YOU RECEIVED IN HIGH SCHOOL OR COLLEGE?
8. IN WHAT EXTRACURRICULAR, COMMUNITY AND/OR VOCATIONAL ACTIVITIES HAVE YOU PARTICIPATED WHILE IN HIGH SCHOOL AND/OR COLLEGE?
9. IF YOU HAVE BEEN EMPLOYED DURING THE REGULAR SCHOOL YEAR WHILE IN HIGH SCHOOL OR COLLEGE SPECIFY TYPE OF WORK AND APPROXIMATE HOURS PER WEEK.
10. HOW HAVE YOU SPENT YOUR SUMMERS DURING HIGH SCHOOL AND COLLEGE?
11. IF YOU HAVE HAD ANY MILITARY SERVICE, COMPLETE THE FOLLOWING:
BRANCH OF SERVICE______HIGHEST RANK______
ENTRY DATE______DISCHARGE DATE______
12. PERSONAL COMMENTS: The Louisiana College Selection Committee places significant weight on this section of your application, as it assists them in developing a greater understanding of you as an individual. You may use this section in any way that you believe should be considered in the evaluation of your candidacy, as well as for amplifying or explaining answers given elsewhere on the form. Some examples of topics that might be pertinent are: motivational characteristics, life goals, unique life experiences, or disadvantaged background. You may use another page if you must. Comments should be focused; they may vary in length but may not exceed 500 words.
13. CERTIFICATION OF STATEMENT: I certify that the information on this application is accurate and complete, and I acknowledge that any omission or inaccurate information could jeopardize my standing with the Louisiana College Early Admissions Program.
14. SUBMIT TO THE CHAIR OF THE LOUISIANA COLLEGE SELECTION COMMITTEE (Dr. Wade Warren) THIS APPLICATION INCLUDING THREE (3) LETTERS OF RECOMMENDATION. (TWO LETTERS MUST BE FROM LOUISIANA COLLEGE SCIENCE FACULTY.) RECOMMENDERS ARE TO PLACE THE RECOMMENDATIONS IN AN ENVELOPE ADDRESSED TO THE COMMITTEE AND SIGN ON THE SEAL. PLACE THE THREE LETTERS ALONG WITH A COPY OF YOUR OFFICIAL TRANSCRIPT WITH YOUR APPLICATION. DEADLINE FOR APPLICATIONS IS JUNE 1.
______
Signature of Applicant Date
RECOMMENDATION #1 (LOUISIANA COLLEGE SCIENCE FACULTY MEMBER)
To the Applicant: Please fill out the top of this form and then forward it to the individual selected to make the recommendation. Please provide the recommender with a self-addressed, stamped envelope so that the recommender may send the letter to you. You are to include the letter (do NOT open the envelope) with your application.
NAME:
ADDRESS:
DATE FORM GIVEN TO RECOMMENDER:
WAIVER OF RIGHTS: I HEREBY WAIVE MY RIGHT TO HAVE ACCESS TO THIS EVALUATION FORM, WHEN COMPLETED, AND UNDERSTAND THAT THIS CONFIDENTIAL RECOMMENDATION IS TO BE USED ONLY IN CONSIDERATION OF MY APPLICATION FOR THE TULANE MEDICAL SCHOOL/ LOUISIANA COLLEGE EARLY ADMISSION PROGRAM.
I do waive my rights. I do not waive my rights.
______
Applicant’s Signature / Date Applicant’s Signature /Date
To the recommender: the person named above is applying for the Tulane University Medical School / Louisiana College Early Admission Program and has requested that your recommendation be included as part of this decision. Please include a statement in the space below regarding the character, integrity, and academic promise of the applicant for this program. Please describe the person’s strengths and weaknesses as they apply to your knowledge of the applicant. You may also use the reverse side of the page if necessary. Please send the letter to the applicant in the envelope he/she has provided. Please seal the envelope and sign and it across the flap.
______
Recommender’s Signature Position Date Returned
RECOMMENDATION #2 (LOUISIANA COLLEGE SCIENCE FACULTY MEMBER)
To the Applicant: Please fill out the top of this form and then forward it to the individual selected to make the recommendation. Please provide the recommender with a self-addressed, stamped envelope so that the recommender may send the letter to you. You are to include the letter (do NOT open the envelope) with your application.
NAME:
ADDRESS:
DATE FORM GIVEN TO RECOMMENDER:
WAIVER OF RIGHTS: I HEREBY WAIVE MY RIGHT TO HAVE ACCESS TO THIS EVALUATION FORM, WHEN COMPLETED, AND UNDERSTAND THAT THIS CONFIDENTIAL RECOMMENDATION IS TO BE USED ONLY IN CONSIDERATION OF MY APPLICATION FOR THE TULANE MEDICAL SCHOOL/ LOUISIANA COLLEGE EARLY ADMISSION PROGRAM.
I do waive my rights. I do not waive my rights.
______
Applicant’s Signature / Date Applicant’s Signature /Date
To the recommender: the person named above is applying for the Tulane University Medical School / Louisiana College Early Admission Program and has requested that your recommendation be included as part of this decision. Please include a statement in the space below regarding the character, integrity, and academic promise of the applicant for this program. Please describe the person’s strengths and weaknesses as they apply to your knowledge of the applicant. You may also use the reverse side of the page if necessary. Please send the letter to the applicant in the envelope he/she has provided. Please seal the envelope and sign and it across the flap.
______
Recommender’s Signature Position Date Returned
RECOMMENDATION #3 (OTHER NON-SCIENCE PROFESSORS, MEDICAL PROFESSIONALS,
EMPLOYERS, MENTORS, etc.)
To the Applicant: Please fill out the top of this form and then forward it to the individual selected to make the recommendation. Please provide the recommender with a self-addressed, stamped envelope so that the recommender may send the letter to you. You are to include the letter (do NOT open the envelope) with your application.
NAME:
ADDRESS:
DATE FORM GIVEN TO RECOMMENDER:
WAIVER OF RIGHTS: I HEREBY WAIVE MY RIGHT TO HAVE ACCESS TO THIS EVALUATION FORM, WHEN COMPLETED, AND UNDERSTAND THAT THIS CONFIDENTIAL RECOMMENDATION IS TO BE USED ONLY IN CONSIDERATION OF MY APPLICATION FOR THE TULANE MEDICAL SCHOOL/ LOUISIANA COLLEGE EARLY ADMISSION PROGRAM.
I do waive my rights. I do not waive my rights.
______
Applicant’s Signature / Date Applicant’s Signature /Date
To the recommender: the person named above is applying for the Tulane University Medical School / Louisiana College Early Admission Program and has requested that your recommendation be included as part of this decision. Please include a statement in the space below regarding the character, integrity, and academic promise of the applicant for this program. Please describe the person’s strengths and weaknesses as they apply to your knowledge of the applicant. You may also use the reverse side of the page if necessary. Please send the letter to the applicant in the envelope he/she has provided. Please seal the envelope and sign and it across the flap.
______
Recommender’s Signature Position Date Returned