WINTHROP PREMEDICAL INFORMATION FORM AND QUESTIONNAIRE

Due by 4:00 pm on February 5, 2018

COMPLETE AND RETURN THIS FORM TO THE RESIDENT DEAN’S OFFICE

This form must be typed and submitted electronically to the Resident Dean’s office (email: ).

Name: ______Non-Resident Tutor: ______

College Address and Phone: ______

Summer Address and Phone: ______

Email Address (include post-Harvard and Harvard): ______

Date of A.B.:______Concentration: ______Honors candidate? ______

Mother’s Occupation: ______

Father’s Occupation: ______

Relatives in Medicine? Where? In what field?

______

______

Are you considering an M.D./Ph.D. program? ______

Please list the persons whom you have asked to write letters of recommendation, and indicate their fullacademic titles and e-mail addresses.3-5 lettersfor MD applicants. 4-6 letters for MD/PhD applicants.

Note: Composition of your house letter will not be initiated until we have received each of the letters listedbelow. This means that you should UPDATE the list if you add or remove letters from your application! Please email Dennis and your resident pre-med tutor to update the list.

NameTitleE-mail address

1. ______

2. ______

3. ______

4. ______

5. ______

6. ______

Tentative list of medical schools to which you are applying (name only is fine; e.g. Harvard, Cornell, Jefferson etc.) The average Harvard student applies to 20 - 30 schools.

If you have taken the MCAT’s already, when did you do so?______

If you have not yet taken the MCAT, when do you plan on taking it? (Before April 2017): ______

What were your scores? (Please forward scores to the Resident Dean’s office when available)

Chem Science _____ Biological Science ______Critical Reasoning ______Social/Behav. ______

What is your overall GPA? ______What is your Science GPA? ______

**Please calculate based on scale of A = 4.0, A- = 3.66, B+ = 3.33, B = 3.0, etc.

Did you transfer to Harvard, and if so from what institution? ______.

List below any classes you have taken for college credit at an institution other than Harvard:

Course Name & Number / Description / Year Taken / Final Grade

Abstracted Resume

1) Please list your major college activities (please list by year and indicate the extent of involvement in terms of hours per week):

2) Please list your employment experience (summer, term-time, volunteer, etc.) by year and indicate approximate hours per week:

3) Please list major academic honors and/or prizes (high school or college):

Winthrop House Premedical Questionnaire

This is a practice run for your AMCAS essay as well as of CRITICAL importance when we write your house letter. The answers to your questions below help us weave together a narrative and story for your letter—trying to describe the sum of what motivates and inspires you to become a physician outside of just grades/activities. You should spend some time answering all these questions. We expect answers to be at least a few paragraphs long for each question below. All answers should be typed (single-spaced) and can replace the lines which are placeholders below. Length should not be a limiting feature. Spend as much time as you need to develop thoughtful responses to the questions.

  1. Why do you want to become a doctor? Or more clearly, what are the origins and brief history of your interest in medicine? Additional points to consider while answering this question:
  2. It’s especially helpful if you can share vignettes from your life which describe situations or experiences which helped you decide that medicine is for you.
  3. You may also add thoughts about any special interests within the field, and any specific sort of career that you envision for yourself in medicine.
  4. Spend some time answering this question—both for us (so we can accurately convey your interests in medicine in your Dean’s Letter) as well as means to crystallize for yourself why you want to apply.
  5. FYI: the AMCAS personal statement has a 5300 character limit
  1. What particular experiences have convinced you that medicine is the right career for you? Examples may include:
  2. working or volunteering in a clinical setting?
  3. helping people in a one-to-one relationship?
  4. having an exciting experience in science?
  1. Academic experience: What led you to select your concentration? In what ways has it fulfilled, and not fulfilled, your expectations? What courses have especially interested you and why? If a non-science concentrator, how do you expect your concentration will contribute to your future development as a physician? If you will write or have written a thesis, discuss the development of your interest in this project.
  1. What is your background and personal story? Tell us more about yourself, your family, and where you grew up. Tell us something about where you come from and how your upbringing has impacted your goals in life. Who have been the most influential people in your life outside of school?
  1. Share with us strengths and weaknesses that you know about yourself. What do you take pride in about yourself? Where are you pushing yourself to develop most as a person? What three adjectives best describe you?
  1. Tell us about strengths in your application, especially those of which the Committee might not otherwise be aware (e.g., medically-related courses you have taken outside the sciences).
  1. If applying MD only, please describe in detail your scientific research experience. Please give details of where, when, length of experience, with whom, content, responsibilities and any publications.
  2. If applying MD/PhD, please give the same details and use this as an opportunity to plan your AMCAS research statement (character count 10,000).
  1. Explain here any special weaknesses or problems presented by your record and background for which you can provide clarification or explanation (e.g., a sophomore "slump", a late decision for medicine, a bad test score in some area, etc.).
  1. a. If you interrupted your college career or took time off from school for any period, describe your activities during that time. In what ways was this time valuable and important to you?

b. If you are planning to take time after graduation, before matriculating to medical school, describe what you will be or are considering doing during your time off.

  1. Employment: What term time and summer jobs have you held, and how intensive were they (both in terms of hours as well as difficulty)? What did you gain from these experiences (other than income)?
  1. Please comment on your personal interests, extracurricular activities, summer activities, hobbies, community service and family circumstances which clarify and broaden the personal picture of you. In what ways have these experiences been instructive and meaningful for you?
  1. What do you see yourself doing 20 years from now? Where do you see yourself in your career? If not medicine, what would you choose to do with your life?

ADDITIONAL REQUIREMENTS:

Please enclose a copy of a draft of your personal statement AND a copy of your resume. We use all of these materials when preparing your House Letter. Thanks for all your hard work!