Bridges to the Baccalaureate Pathways to Biomedical
Sciences Application
DEADLINE for SUBMISSION: September 21, 2012
Please save this application word file with the file name BridgesApp_first initial.last name (Example: BridgesApp_J.Doe).
In addition to this application, please scan an unofficial copy of your Community College transcript(s), as well as High
School transcripts if they list International Baccalaureate (IB) and/or Advanced Placement (AP) exam scores.
Name this file BridgesTrans_first initial.last name (Example: BridgesTrans_J.Doe).
Email your application and transcripts as attachments with a subject line ‘Bridges and your name’ to:
Julia Tossetti JTo80@aol.com
General Information (Please fill in or check the following boxes)
Last Name:
Gender:
First Name:
M
M.I.
U.S. Citizen?
Yes
No
If not, Permanent Resident #
F
Date of Birth (Month-Day-Year)
/
/
Student ID #
Permanent Mailing Address:
Number and Street
City
Zip
Day Phone
Evening Phone
Area Code Number
Area Code Number
Cell Phone
E-Mail Address
Area Code Number
Current Community College:
LAPC
LAVC
other (specify)
Ethnicity:
Black/African American
Caucasian
Chicano/a/Mexican American
Latino/a
Multi-racial (please specify)
Native Alaskan (indicate tribal affiliation)
Native American (indicate tribal affiliation)
Native Polynesians (Hawaiians, Samoans, Guamanians) (specify)
Puerto Rican
Asian American (please specify)
Other (please specify)
Are you currently enrolled at a baccalaureate granting institution?
Do you currently hold a Bachelor’s Degree?
Yes
No
Are you interested in transferring to UCLA?
Yes
No
Yes
When?
No
If not, list other colleges that you would like to transfer to after finishing community college:
Proposed Undergraduate Major(s):
Ultimate Degree Objective:
B.S. Only
Are you currently receiving financial aid?
M.D.
Ph.D
Yes
Do you plan to work during the academic year?
Undecided Other (specify)
No
Yes
No
If yes, planned hours per week
Completed Coursework (check the following boxes as completed and specify indicated information)
Highest Math class (course number)
Chemistry 60 (instructor/semester)
Biology 6 (instructor/semester)
Chemistry 101 (instructor/semester)
Biology 7 (instructor/semester)
Chemistry 102 (instructor/semester)
If you have taken courses equivalent to these outside the Los Angeles Community College District, please indicate the
course(s) and college(s) where taken:
In no more than 250 words, please address each of the following questions.
If possible, please compose your essay in advance on a word-processor, then cut and paste it into the space below.
What experience(s) made you realize that you want to be a science major in college?
How will you promote diversity in your academic and/or professional career?
For more information, please contact:
Professor Lyn Koller kollerlm@piercecollege.edu or Professor Izzy Goodman goodmaii@piercecollege.edu