MCAT Study Academy
2015-2016 Application Form
Due at 5pm on Oct. 30
PROGRAM DESCRIPTION:
The MCAT Study Academy is a student-driven study group designed to engage disadvantaged or underrepresented
individuals with an educational opportunity to promote high quality scores on the Medical College Admissions Test (MCAT).
Our mission is to reach out to students who are interested in pursuing a career as a physician, but who also have untold
stories of personal hardship due to disparities of racial/ethnic, socioeconomic, or environmental origins. This program
strives to utilize a team-based approach to MCAT preparation, leveraging the knowledge of current medical students,
prospective medical students, and fellow undergraduate/graduate students to achieve academic success. The goals of this
program are to increase confidence and aptitude of students preparing to take the MCAT, along with fostering the idea of
teamwork in achieving the common goal of medical school matriculation.
By participating in the program, students will have access to a unique and innovative MCAT preparation. The MCAT Study
Academy will provide the Myers Briggs Learning Assessment which will determine the personality characteristics of
students to facilitate teamwork of peers with complimentary personalities and learning styles. Participants will also have
access to AAMC MCAT exams, MCAT passages, and free standing questions for every subject.
Additionally, outside of MCAT preparation, participants will have access to current medical students from University of
Colorado School of Medicine to provide guidance through the application, interview process, and moving forward. The end
of the program will feature an informal gathering for students to socialize with current medical students and important
faculty from the School of Medicine and Anschutz Medical Campus. Funding will be provided for up to 15 students; for
these individuals the MCAT Study Academy and materials are completely FREE!
PROGRAM ELIGIBILTY & REQUIREMENTS:
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Minimum cumulative GPA of 3.3 (preferred 3.5)
Complete application & essays
Must be at least hold junior class standing with all prerequisites completed prior to starting program
Must be available Saturdays from 8am-5pm from mid-January to early May
o Must also be able to commit to 2-3 hours during the week for group study sessions.
Must be planning on applying to Medical School within the next two application cycles
Must be planning on taking the MCAT within a year following completion of the program
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1.
STUDENT’S INFORMATION:
_______________________________________________________
Student’s Name (Last, First and Middle Initial)
_____________________________
Date of Birth (mm/dd/yyyy)
____________________________________________________________________________________________________
Street Address, City, State, and Zip Code
Email Address: ___________________________________________________
Gender (circle one):
Male
Female
Phone # ________________________________ Cell Phone # __________________________________
Check all that apply (optional): __African-American or Black
__Hispanic/Latino
__Native Hawaiian/Pacific Islander
__American Indian or Native American
__Asian__________(Country of Origin) __Caucasian/White
_______________________________ __________________
Name of School Currently Attending Other Institution
Expected Graduation Year:___________
_________________ ___________________
Year in School
Cumulative GPA
Major(s):____________________
Minor(s):___________________
What prerequisite premedical courses have you taken or are enrolled in? (Biology, General & Organic Chemistry, Physics,
etc):
_______________________________________________________________________________________________
What courses will you be enrolled in during the Spring of 2015?:
______________________________________________________________________________________________
Have you ever won an academic honor award? No__ Yes__ If yes, please list what year(s) and semester(s):
________________________________________________________________________________________________
Have you ever taken the MCAT before? No__ Yes__
If yes, number of times taken and score(s) earned:
_______________________________________________________________________________________________
Do you need any accommodations, e.g., physical, dietary? No__ Yes __
If yes, please explain:
_________________________________________________________________________________________
Have either of your parents completed a 4-year college degree in the U.S.?_____________
Is English your first language? No__ Yes__
Are you proficient in other language(s) (specify)?______________________________________________
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Do you qualify for the Federal Pell Grant or have qualified in the past? (This information can be found by asking
your financial aid advisor) No__ Yes__
Would you say you have experienced financial hardship? No__ Yes__ if yes, please explain briefly
___________________________________________________________________________________________
2.
EMERGENCY CONTACT INFORMATION:
__________________________________________ ________________________________________
Name
Relationship to the student
________________________________________________________________________________________
Street Address, City, State, and Zip Code
(______)__________________________________
Best number to reach
(______)_________________________________
Home/Cell Number
_________________________________________
Email
3.
COMMUNITY SERVICE AND WORK EXPERIENCE:
Please list any Community Service experience: ____________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Please list and describe any relevant work experience:_______________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Previous/Current employer contact information:____________________________________________________
____________________________________________________________________________________________
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4.
ESSAY QUESTIONS (PLEASE ATTACH AS A SEPARATE WORD DOCUMENT:
The design of the MCAT academy is a team-based approach to learning. What qualities do you feel you can offer
to this team-based environment? (IN 300 WORDS OR LESS, PLEASE)
Describe an instance when you or an individual close to you experienced hardship. Please describe how you
were able to emerge/aid the individual from such hardship. (IN 300 WORDS OR LESS, PLEASE)
During one’s course to becoming a physician, there are often events and people who inspire us. Please describe
on of these instances. (IN 300 WORDS OR LESS, PLEASE)
Optional: If you feel your GPA does not accurately reflect your academic capabilities, please explain why. (IN 300 WORDS
OR LESS, PLEASE)
5.
SIGNATURE CONFIRMATION:
I attest that to the best of my knowledge, the information submitted on this application is true and complete. I
understand that if found to be otherwise, it is sufficient cause for refusal or dismissal from the program.
Signed: ________________________________
Date: _______________
Questions?
Christian Valtierra| Christian.Valtierra@UCDenver.edu or 303-724-8001
Assistant Director, Office of Diversity and Inclusion | University of Colorado Anschutz Medical Campus
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