Questionnaire for Faculty Evals Meeting with Junior Premeds (Revised 8/9/15)
Name _____________________________________________________________Date ______________
1. To what kind of school(s) will you be applying summer 2016 for entry in 2017?
File Your Evaluation Letters in PM Office for These HP Schools
!Medical (MD)
!Medical (DO)
!Dental
! Post-Bacc (varies)
!Podiatry
! Chiropractic (varies)
Do NOT File Evaluation Letters in PM Office for These HP Schools (evals must be submitted electronically)
!Veterinary
! Optometry
!Public Health
!Physician Assistant
! Physical Therapy
! Grad School
!Other school or program not listed above________________________________________________
2. What are your plans for summer 2016 (NOTE: This is the LAST summer to gain medical/clinical or other
relevant experience if you hope to enter in 2017)?
3. What were your mid-term grades in each course that you are currently enrolled in? List each course and the
corresponding grade (if you dropped a course, still include it).
Course
Mid-Term Grade
4. How many semester hours will you be taking NEXT semester?
_________
•How many of these are BCPM (Biology, Chemistry, Physics, Math) hours? _________
5. Which admission test do you plan to take? _____________
•When will you take it (DATE)?
_______________
•Which review course (or course materials if not enrolling)? ________________________________________
•When will you begin preparing for the MCAT, DAT, etc.? ________________________________________
•If taking the MCAT, check courses below that you will have completed by the end of Spring
2016…
!Gen Chem 1&2 !Gen Bio 1&2
! Intro Psychology
!Organic 1&2
!Physics 1&2
! Biochem I
! Statistics
! Intro Sociology
(OVER)
6. According to the Instructions for Collecting and Sending Letters of Evaluation (READ THE ENTIRE
DOCUMENT CAREFULLY), what three items must be submitted to EACH faculty member who agrees to write
an evaluation to be filed in the PM Office on your behalf? NOTE: If you are applying to a school that ONLY
accepts letters of evaluation electronically, you should NOT have your evaluations filed in the Premedical
Office----you must give each evaluator specific instructions for completing the ONLINE evaluation form(s)!!!
1)_______________________________________
2)_______________________________________
3)_______________________________________
7. Have you submitted the following items to be critiqued by the Premedical Office at least once since August
2015 (i.e. to Sr. Joanne for review at xupremed@yahoo.com)?
Personal Statement
!Yes !No
If No, what date will you submit?_________
Post-Secondary Experiences
!Yes !No
If No, what date will you submit?_________
8. Most medical, dental, etc. schools require evaluations from people who TAUGHT you. Although you can get
letters from doctors, research mentors, work supervisors, etc., evaluations from people who actually taught you are
almost always required.
List TWO (2) faculty who taught you a BCPM course [THREE (3) who taught you a BCPM lecture if you are
applying to LSU-NO Medical School]* and ONE (1) faculty who taught you a non-BCPM course who you wish
to ask to write letters of evaluation on your behalf. If you are applying to LSU-S Medical School, your evaluations
cannot be dated prior to 5/1/2016, NOTE: Required evaluations MUST come from people who have taught
you (and preferably whose courses you got no less than a “B”) and at least one of the BCPM letters should be
from a faculty member in Biology (if possible).
•BCPM
1) _______________________________________________
2) _______________________________________________
*3) _______________________________________________(3 lecture for LSUNO)
4) _______________________________________________(alternate BCPM))
*Must be 3 LECTURE TEACHERS who taught you (cannot have ONLY taught you lab) if you are applying to LSU-New
Orleans Medical School. If applying to LSU-Shreveport Medical School, your letters cannot be dated prior to 5/1/2016.
•Non-BCPM
1) _______________________________________________
2) _______________________________________________(alternate non-BCPM)
9. The table below applies to evaluations for summer program applications. Next to each evaluator’s name, check
whether or not the letter is already filed in the PM Office OR if you will ask the teacher to write the summer
program letter on your behalf.
Summer Program Evaluator’s Name
Filed in PM
Will Ask