Questionnaire #1 for School Selection Meeting (12/29/15)
Name __________________________________ Date ______________
1) To what kind of school(s) will you be applying to in 2016 for entry in 2017?
❏Medical (MD)
❏Medical (DO)
❏Dental
❏Other_____________
2) What were your final grades for Fall 2015 (list courses and grades)?
3) What are your current grades for Spring 2016 (list courses and grades)?
4) Describe ALL medical or clinical experience (i.e. working directly with a patient population)
you have had since graduating from high school?
5) What are your plans for summer 2016?
6) What was your total...
SAT score?________ ACT score?_______
7) Which admission test do you plan to take?
•Date you will take it?
__________
_______________________
•Have you registered to take the test? ________
•How are you preparing for the admission test?
!Kaplan Course !Princeton Course !Examkrackers Course !Self-Study
!Other __________________________
•How many hours did you spend LAST week in your review class?
...studying for the test OUTSIDE of your review class?
_______________
_______________
•Are you up-to-date with online practice tests/assignments for your course? _____________
(course “guarantees” only apply if you complete ALL work!!!)
(OVER)
8) FOR MED (MD & DO) Applicants ONLY: We recommend that all Xavier students apply
to 10 and that CA residents apply to 12. Approximately, how much do you think it will cost
to apply to 10 schools via the primary application service (Hint: Fees are available on
application websites; ONLY COMPLETE FOR THE APPLICATION SERVICE(S) YOU
PLAN ON USING)…
•For AMCAS (MD application)?________
•Did YOU get FAP Approval? ________
•For AACOMAS (DO application)? ________
•For TMDSAS (Texas MD and DO application)? ________
9) FOR DS/PD/OD/VT Applicants ONLY: We recommend that students apply to 5
DS/PD/OD/VT schools. Approximately, how much do you think it will cost to apply to 5
schools via the primary application service (Hint: Fees are available on application websites;
ONLY COMPLETE FOR THE APPLICATION SERVICE(S) YOU PLAN ON USING)…
•For AADSAS (dental application)?________ •Did YOU get FAP Approval? ________
•For TMDSAS (Texas dental application)? ________
•For AACPMAS (podiatry application)? ________
•For OptomCAS (optometry application)? ________
•For VMCAS (veterinary application)? ________
•Other heath professions school application (type and cost) ___________________________
10) OTHER:
•What evaluations do you already have on file IN THE PREMED OFFICE to support your
PROFESSIONAL school (medical, dental, etc.) application?
•For evaluations that are NOT on file to support the above mentioned applications, please
indicate your status below…
!I have asked teachers but have NOT yet given them the required items.
!I have asked teachers AND have given them the items required to write the evaluations.
!I have done neither of the above but will do so by (date)_________________________.
REMINDER: Students applying to LSU-S Medical School Letters must be dated 5/1/16 or later AND students
applying to LSU-NO Medical School need 3 BCPM evaluations (lecture teachers) and 1 non-BCPM evaluation.
•Have you submitted the following items to be critiqued by the PM Office at least ONCE in
Spring 2016 (since January 2016)? NOTE: April 30, 2016 is the LAST day we will
review individual items for 2017 applicants!!!
Personal Statement
!Yes !No
If No, what date will you submit?_________________
Post-Secondary Exp. !Yes !No
If No, what date will you submit?_________________
11) Residency, in terms of applying to medical, dental, etc. school, often has nothing to do with
where you CURRENTLY reside. Instead, each school has their own definition of “residency”
(e.g. where your parents live, where you graduated from high school, etc.). It is imperative that
you research the schools to which you are interested in applying to be clear on their residency
rules. Be advised that you cannot claim to be a resident of more than one state when applying to
medical, dental, etc. school.
•What state will you claim as your “state of residence” on your professional school application?
__________________________________
12) In addition to the required math and science courses, some schools now require other courses
[e.g. statistics, Howard Dental School requires two (2) semesters of A&P]. Also, schools may
have additional letter of evaluation requirements. The ultimate responsibility of identifying ALL
coursework and other requirements for the schools you plan on applying to rests on YOU, the
student.
•Do you understand that YOU must research the coursework and other requirements for the
health professions schools that you are interested in applying to in order to make certain you are
fulfilling those requirements? ❏Yes ❏No
13) XU’s Premedical Advisers recommend that students take Intro Biochemistry and at least two
(2) of the remaining four upper-level courses listed below to help build a foundation for the
TOUGH first year of basic medical sciences in most health professions schools. In the table
below, indicate when you took or might take those recommended courses.
Course at
XU
RECOMMENDED (Biochemistry and at least 2 of the
other courses listed)
Intro Biochemistry (already required for “premed”
majors and needed for MCAT—by Spring 2016)
Comparative Anatomy
Embryology
Histology
Anatomy and Physiology
OTHER POSSIBLE
REQUIREMENTS/RECOMMENDATIONS
-Statistics (a number of schools starting to REQUIRE plus a
foundational skill for MCAT)
-Calculus II and above (e.g. required by some schools)
-Anatomy & Physiology I & II (e.g. required by Howard
Dental School)
-Ceramics (recommended for dental school applicants)
-Intro to Psychology (MCAT discipline)
-Intro to Sociology (MCAT discipline)
CHEM
3130/3130LB
BIOL
4091/4091LB
BIOL
3162/3162LB
BIOL
4111/4111LB
BIOL
3350/3350LB
CHEM
1021LB
Fall15
Spr16
Fall16
Spr17
Other