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Feb 12, 2017

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Advisors Student

Applicant Portfolio

(A.S.A.P.)

Prepared by the

HEALTH PROFESSIONS ADVISORY OFFICE

Vanderbilt University

PMB 321

230 Appleton Place

Nashville, TN 37203

(615) 322-2446

[email protected]

Please review the following requirements:

1. An Advisors Student Applicant Portfolio (ASAP) meeting/interview is required in order for the Health Professions Advisory Office (HPAO) to prepare a committee letter from this office to a health professions school. (This meeting is strongly recommended since most health professions schools require and/or expect to receive a letter from the schools health professions advisor if a student is still enrolled or has just graduated.) These meetings can be scheduled to take place as early as February of the application year. The HPAO should be contacted well in advance of the preferred meeting date since the calendar fills up quickly.

2. This packet must be typed and completed IN ITS ENTIRETY and provided to the HPAO prior to the beginning of the ASAP meeting/interview. (If the meeting is in person, the completed document can be brought to the meeting. If the meeting is over the phone, the completed document must be faxed or emailed to the HPAO at least three business days prior to the meeting.) Committee letters are based in part on your interview with the Health Professions Advisor AND the information you provide in this document, so ample time and attention should be given to your responses. In addition to providing a hardcopy to the HPAO, please retain a hardcopy for your records. Some faculty members may also require a copy in order to write a recommendation letter.

3. If you arrive to the ASAP meeting later than 10 minutes past your appointment time or have an incomplete packet, the meeting will automatically be cancelled and you will be asked to reschedule for the next available date which could be weeks away.

4. If additions or changes are made to the list of recommendation letter writers or the list of schools to which you are applying, those changes must be emailed to the HPAO immediately upon determination.

5. Answers must be typed, and character/space limitations must be met! (The document will NOT alert you if the character limit has been exceeded. You must highlight your text and monitor your character usage.) Health Professions Applications (such as AMCAS and TMDSAS) limit the number of characters you may use, so it is important to be able to answer succinctly.

6. Carefully read the Health Professions Advisory Office Notice Regarding Rights under the Family Education Rights and Privacy Act and Request for Committee Letter (Page 11). After you have read this page, check the appropriate box, sign, and date the document. The ASAP meeting cannot take place unless the HPAO has this completed page including a hand-written signature.

7. The committee letter written by the HPAO will not be finalized until all letters of recommendation have been received AND your application has been submitted.

8. The final page of this packet is the Recommendation Letter Request and Waiver. You are to complete the top portion of this form and give a signed copy to each of your letter writers. You should also specify the requested due date in the middle of the form. Please ask each letter writer to complete the bottom portion of this form and returned it to the HPAO, along with his/her recommendation letter. You must also include a signed copy in your ASAP packet for the HPAO. The ASAP meeting cannot take place unless the HPAO has this page with the top portion completed including a hand-written signature.

9. Please sign and confirm that you have thoroughly read all of the above instructions.

Signature: _________________________________________ Date: ______________

BACKGROUND INFORMATION

In order for the Health Professions Advisory Office Director to write a committee letter on your behalf, you must return this completed form prior to or at the time of the ASAP meeting/interview. A photograph is also required. The meeting will NOT take place if the form is not completed or the photo is not provided.

*** BIOGRAPHICAL INFORMATION ***

FULL NAME:Click here to enter text.

PHOTO

*** REQUIRED ***

1) NAME/NICKNAME YOU PREFER:Click here to enter text.

2) EXPECTED DATE OF GRADUATION:Click here to enter text.

3) DEGREE TO BE EARNED:Click here to enter text.

4) MAJOR(S):Click here to enter text.

5) MINOR(S):Click here to enter text.

6) YEAR OF APPLICATION:Click here to enter text.

7) CAREER GOAL:Click here to enter text.

(Medical, MD/PhD, Dental, Veterinary, Pharmacy, Other-Specify)

8) DATE OF BIRTH:Click here to enter text.

9) EMAIL ADDRESS:Click here to enter text.

10) PERMANENT ADDRESS:Click here to enter text.

Click here to enter text.

11) PHONE NUMBER - CELL:Click here to enter text.

12) PHONE NUMBER - HOME: Click here to enter text.

13) PARENTS & SIBLINGS OCCUPATIONS (Please give institution granting M.D. if relative is physician.)

FATHER:Click here to enter text.

MOTHER:Click here to enter text.

SIBLINGS:Click here to enter text.

14) COURSE LISTING: For each of the following courses, please list the semester the course was taken (Ex: FR1, FR2, FR3{summer},SO1SR2), your instructor, and your grade. If you have attended other universities; mark non-Vanderbilt courses with an asterisk (*):

SEMESTER/INSTRUCTOR/GRADESEMESTER/INSTRUCTOR/GRADE

Chem 102a:Click here to enter text.Chem 102b:Click here to enter text.

Chem 220a:Click here to enter text.Chem 220b:Click here to enter text.

BioSci 110a:Click here to enter text.BioSci 110b:Click here to enter text.

Physics 116a:Click here to enter text.Physics 116b:Click here to enter text.

15) DATE ON WHICH ADMISSION TEST WAS (OR WILL BE) TAKEN:Click here to enter a date.

Applicable Score: MCAT V(score?) PS(score?) BS(score?) TOTAL(score?)

DAT Academic (score?) Perceptual (score?)

GREV(score?) QT(score?) W(score?)

OtherClick here to enter text.

16) NAME(S) OF COLLEGE(S) OTHER THAN VANDERBILT THAT YOU HAVE ATTENDED:

Click here to enter text.

17) GPA AT VANDERBILT:Click here to enter text.

LIST GPA EARNED EACH SEMESTER AND SUMMER (This can be found on YES):

1st: Click here to enter text.2nd: Click here to enter text.Summer: Click here to enter text.

3rd: Click here to enter text.4th: Click here to enter text.Summer: Click here to enter text.

5th: Click here to enter text.6th: Click here to enter text.Summer: Click here to enter text.

7th: Click here to enter text.8th: Click here to enter text.

18) PLEASE ANSWER THE FOLLOWING QUESTION WHICH IS ASKED IN VARIOUS FORMS ON ALL HEALTH PROFESSIONS APPLICATIONS:

WERE YOU EVER THE RECIPIENT OF ANY ACTION (e.g., DISMISSAL, SUSPENSION, DISQUALIFICATION, ETC.) BY ANY COLLEGE OR OTHER INSTITUTION FOR UNACCEPTABLE ACADEMIC PERFORMANCE OR CONDUCT VIOLATIONS? Choose an item.

IF YES, EXPLAIN FULLY IN PERSONAL COMMENTS (SECTION 29)

19) LIST SUBSTANTIVE ACTIVITIES IN SERVICE (Any not just pre-health), RESEARCH, AND EXPOSURE TO THE HEALTH PROFFESSIONS IN WHICH YOU PARTICIPATED DURING HIGH SCHOOL. (All

(700 characters maximum including spaces)

Click here to enter text.

20) HOW DID YOU SPEND THE SUMMERS DURING HIGH SCHOOL?

(700 characters maximum including spaces)

Click here to enter text.

21) HOW AND WHEN DID YOU BECOME INTERESTED IN THE HEALTH PROFESSIONS?

(1000 characters maximum including spaces)

Click here to enter text.

*** COLLEGE ***

22) HAVE YOU BEEN EMPLOYED DURING THE REGULAR SCHOOL YEAR? Choose an item.

DESCRIBE JOB(S) HELD:

JOB TITLE: Click here to enter text.

AVG HRS/WK?Click here to enter text. # SEMESTERS? Click here to enter text.

JOB DESCRIPTION: (700 characters maximum including spaces)

Click here to enter text.

JOB TITLE: Click here to enter text.

AVG HRS/WK?Click here to enter text. # SEMESTERS? Click here to enter text.

JOB DESCRIPTION: (700 characters maximum including spaces)

Click here to enter text.

(LIST MORE JOBS IF APPLICABLE)

Click here to enter text.

23) LIST ANY HONORS RECEIVED INCLUDING MERIT SCHOLARSHIPS, HONORARY SOCIETIES, ELECTED OFFICES, ETC.

Click here to enter text.

24) IN ADDITION TO YOUR ACADEMC PERFORMANCE, HEALTH PROFESSIONS SCHOOLS ARE INTERESTED IN THE SERVICE/VOLUNTEER ACTIVITIES THAT YOU HAVE ACTIVELY PURSUED.

A) Most important activity to you:

Name/Type of Activity: Click here to enter text.

Dates of Participation (mm/dd/yy): Click here to enter text. - Click here to enter text.

Number of Semesters Participating: Click here to enter text. Average Hrs/Wk: Click here to enter text.

Details: (700 characters maximum including spaces)

Click here to enter text.

B) Second most important:

Name/Type of Activity: Click here to enter text.

Dates of Participation (mm/dd/yy): Click here to enter text. - Click here to enter text.

Number of Semesters Participating: Click here to enter text. Average Hrs/Wk: Click here to enter text.

Details: (700 characters maximum including spaces)

Click here to enter text.

C) Next most important:

Name/Type of Activity: Click here to enter text.

Dates of Participation (mm/dd/yy): Click here to enter text. - Click here to enter text.

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