Student Supplement to the Committee lor interview
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| Student Supplement to the Committee LOR Interview
Name_______________________________________ SS#_______________________ DOB_____________ Major (s)_________________Minor(s)______________ Are you in the pre-med program?________________ AMCAS/AACOMAS/PCAS/CASPA ID, if assigned _______________________________________________
Physical Address__________________________________________________________ Email Address____________________________________________________________ Cell Phone Number _______________________________________________________ Type of school to which you are applying (i.e., medical, osteopathic medical, dental, etc). Are you planning to take a year off? If so, your portfolio should be as complete as possible before graduation. It is your responsibility to notify me of changes in contact information. Are you requesting a committee letter (LOR) or a letter packet? _____________________________________ Admission Test you have/will be taking (i.e., MCAT, GRE, PCAT, etc.)__________ Test Date _________________ Score (if taken) _________________ Score Range ______________ Scholarships Received and Dates (Give specific information about the basis on which you were granted non-Messiah Scholarships and renewal information for Messiah scholarships). Scholarship Name Years Rec’d / Details Dean’s
Emerging Leadership Honor’s Program Provost’s Multicultural Others
Check your PIF to make sure that I have specific information about your co-curricular, research and medically related experiences. I need details, such as a complete description of your involvement, when you were involved (i.e., fall, 2009 – present or fall, 2008 – spring 2010), your supervisor’s name, hours worked, etc. I may wind up quoting you, so please submit any additions or corrections with this paper. I will need the following materials at the time of our meeting or shortly thereafter BEFORE I begin your letter: 1. A copy of all of your unofficial transcript(s) that includes spring , 2010 grades 2. A copy of your completed application 3. Admission test scores (please notify me by email and then follow up with an official score report) Note: Failure to follow PHPAC procedures and timelines may result in a letter packet, rather than a committee LOR, being sent. Please bring this completed form to your Committee Interview. Updated 4/11 |