PRE-PROFESSIONAL HEALTH SCIENCES QUESTIONNAIRE
“Goldenrod Form”
Student Name: ______Date: ______EMU Student ID #: ______
Aprocessing fee of $5 will be charged to the student account of any applicant who is a current EMU student. Students who have already graduated from EMU are asked to mail a check of $5 to the Science Center Secretary.
Major: ______Health Science Program: ______
Minor: ______Current GPA: ______Year of Graduation from EMU: ______
GRE, DAT, or other Entrance Exam Scores ______
MCAT Scores: ______Verbal Reasoning ______Physical Sciences ______Biological Sciences
-OR-
MCAT 2015 Scores:_____ Biological Systems _____ Chemical Systems
_____Social & Behavioral Science _____Critical Reasoning Skills
1.How long have you been interested in this area of health sciences as a career?
2.Why are you interested in the health sciences and what do you feel you can contribute as a member of your chosen profession?
3.What extracurricular activities have you participated in that have been especially significant or that have taken considerable time (e.g. SGA, WEMC, Weather Vane, RA, Drama, committee member, athletics, etc.). How may they be related to preparation for your chosen career?
4.What community or church (noncollege) activities either in Harrisonburg or in your home community have been important to you?
5.What honors or important positions have you held? (e.g. class officer, RA, Y or SGA office, scholarship award, athletic honor, etc.) Have you actively participated in the PPHS society?
6.What factors, if any, may have adversely affected your standardized test scores (MCAT, DAT, GRE, etc.) or GPA?
7.What experience, if any, have you had in healthrelated work? Please describe any people-related volunteer programs in which you have participated.
8.How do you feel you have changed in goals, attitudes, abilities, motivation, etc., during your experience at EMU?
9.Discuss your faith pilgrimage and how the EMU community and your chosen career have or will relate to it.
10.What would you like us to emphasize about you in our letter? What is your strongest qualification?
11.What do you consider to be your greatest weakness? What would you most like to change about yourself?
12.What alternatives to your chosen career or school have you seriously considered? Why have you chosen these?
13.List three persons (non-science college teachers, administrators, pastors, etc.) who can give us an evaluation of your academic work and/or character. Include the courses or relationships you have had that formed the basis of this evaluation. (If you are a transfer student, give the name and address of professors from your previous school who may give a helpful evaluation.)
14.If pre-medicine, are you applying for "early decision" or the "M.D./Ph.D. combined program?"
15.What will be your summer address and phone number? What is your permanent address and phone number?
16.Please include any additional information which you feel might be helpful in evaluating your character/potential.
Finally, append to this form a one- or two-page resume. Return this form and the attached resume to either Jeff Copeland () or Diane Bowman () as an email attachment.
*NOTE: If you need letters of recommendation please complete a reference letter request form, available on-line. Please keep us apprised of the status of your application; we are concerned and care if you are accepted or rejected by a particular school.