Pre-Professional Advising Office
Student Information Packet for Committee Letter – 2017 cycle
Check one:
Medical ___
Dental ___
Optometry ___
Podiatry ___
Section I – Personal Information
Name:
Date:
Graduation Year:
Permanent/Home Address:
Non-Muhlenberg Email:
Cell Phone:
Home Phone:
Questions:
1. What are your core talents?
2. What is the biggest challenge you have had to overcome? What did you learn from this
experience?
3. What do you consider to be your three greatest strengths as a candidate? Please
describe.
4. Do you believe you have any weaknesses as a candidate? Please describe.
5. The following question appears on the AMCAS application: “Were you ever the recipient
of any institutional action by any college or medical school for unacceptable academic
performance or conduct violations?” If your answer to this question is “yes,” please
explain in detail and discuss the matter fully with your pre-health advisor.
(Note: You must answer “yes” even if the action does not appear on or has been deleted from your
official transcript due to institutional policy or personal petition.)
6. Do you have a criminal record of any kind, beyond minor traffic tickets? If yes, please
describe in detail.
Section II – Academic Record / Test Scores
Major(s):
Minor(s):
Overall GPA:
BCP(M) GPA:
MCAT/DAT/OAT/GRE Scores:
Questions:
1. To what extent do you feel that your academic record and test scores properly
represent your candidacy to this profession?
2. Have you taken courses at other colleges or universities since graduation? List schools,
dates attended and courses taken.
3. Were you a DANA scholar, Muhlenberg Scholar or RJ Fellow? If so, what does having this
distinction mean to you?
4. Discuss your most valuable academic experience and why it was so significant.
Section III – Experience
For each of the following, list all of your involvement in detail. Include what you did, dates, total
hours, what you found most/least interesting, and what you learned from each experience.
1. Shadowing/Internships/Other Clinical Experience
2. Community/Volunteer Service (non-clinical)
3. Research
4. Leadership
5. Other Extracurricular Activities
6. Paid Jobs/Employment
Section IV – Career Readiness
1. What draws you to this career?
2. How do you assess your preparation and chances of admission to professional school at
this time and why?
3. What plans do you have if you are not admitted to professional school this cycle? Have
you considered alternative careers? If not, why not?
4. If you are an alumnus/a or are taking a year or more off between MC and professional
school, please describe your plans as specifically as possible.
5. Paint a picture for me and tell me what you ideally see yourself doing in 10-15 years.
Section IV – Evaluations / Letters of Recommendation
List the individuals you are asking for evaluations/letters. You should have at least 3 science
faculty – preferably from different disciplines. If you are applying to osteopathic medical school,
one of your letters must be from a D.O.
Science Faculty
Non-Science Faculty / Non-Faculty
1 ________________________
1 ________________________
2 ________________________
2 ________________________
3 ________________________
3 ________________________
4 ________________________
4 ________________________
Section V – List of Schools
Provide a tentative list of the professional school to which you plan to apply. Please limit your
list to 20 schools.
1 _________________________________
11 _________________________________
2 _________________________________
12 _________________________________
3 _________________________________
13 _________________________________
4 _________________________________
14 _________________________________
5 _________________________________
15 _________________________________
6 _________________________________
16 _________________________________
7 _________________________________
17 _________________________________
8 _________________________________
18 _________________________________
9 _________________________________
19 _________________________________
10 _________________________________
20 _________________________________
Are you applying to any dual degree programs? (i.e. MD/MPH, MD/PhD, etc.) If so, where?
Are you applying Early Decision? If so, where?
Section VI – Personal Statement (Draft)
(This should be one full page single spaced – 5300 characters including spaces)
The personal statement should not be used to summarize all of your college experiences or to give the
chronological history of your decision to choose medicine. Instead, use the essay to discuss in depth one
or two experiences, in which you were an active participant, that illustrate qualities that make you a
strong candidate. Ideally, the personal statement will have a unifying theme, provide detailed and
concrete examples of things you have done, and convey your maturity and capacity for self-reflection.
Although you may be tempted to discuss your childhood, it is your experiences and choices as an adult
that are relevant to admissions committees. An effective personal statement will convey your
commitment to medicine as well as your “fit” for the profession.
Section VII – Waivers / Signatures
1. I plan to request evaluation letters from the persons listed in Section IV with the
understanding that these letters will be made available to health professional schools. I
authorize the Pre-Professional Office to prepare a committee letter of evaluation for me
with the understanding that it will be made available to the institutions I have indicated.
This is to include the schools listed in Section V and any schools that I may later specify in
writing and on my professional school application. A copy of my evaluations and committee
letter may also be used in support of my candidacy for relevant prizes, awards, fellowships,
or grants for which I may apply. These materials will not otherwise be used without my
written consent.
The statement is provided in connection with the Family Educational Rights and Privacy Act of 1974.
Signature ___________________________________________________________________
2. I give permission to the Director, Pre-Professional Advising to review my disciplinary records
held in the Deans’ Offices. This will include all formal actions including: probation,
suspension and expulsion, and any accompanying conditions. By signing below, I am
requesting that the Pre-Professional Office prepare and send a committee evaluation
packet to the programs designated in Section V and any schools that I may later specify in
writing and on my professional school application.
Signature ____________________________________________________________________
3. PLEASE READ AND SIGN ONE OF THE STATEMENTS BELOW:
A. These letters are confidential and will not be made available to me without prior
consent of the authors.
Signature _____________________________________________________________
B. I retain my right of access to these letters. I have discussed this decision with the
Director, Pre-Professional Advising.
Signature _____________________________________________________________