Ben-Gurion University of the Negev- Faculty of Health Sciences
Medical School for International Health
2016 Application for Admission
Applicant Personal Data
Full name:
First
Middle Name (if no middle name, please indicate “no middle name”) Last
Please include your full legal name: first, middle and last. If you do not have a middle name, please indicate “no middle name”. Please
note: this is how your name will appear on your transcript, diploma and all other university documents.
☐
☐
Birth date:
Female
/
Male
/
month
day
year
Last four digits of Social Security/National Identity number:
Place of birth:
City
State/Province
Country
Legal permanent address:
Street
Permanent phone number:
Apt
City/State
Country
Postal Code
Email address:
Preferred mailing address:
Street
Apt
City/State
Country
Preferred phone number:
☐Single
☐ Married Number of children: ☐ none ☐one
Citizenship(s): (List every country of citizenship):
Passport number(s):
Issuing Country(s):
Father’s name, citizenship and occupation:
Mother’s name, citizenship and occupation:
Academic Information
☐two +
Postal Code
High school attended:
State/Country
If you did not attend college immediately after high school, or if there was more than a six-month
break in your studies, briefly state the reasons.
Undergraduate college/university:
Dates attended:
GPA:
State/Country
to
Degree:
Science GPA:
Total MCAT score:
Major:
Class rank/standing (if available):
MCAT verification code:
AAMC ID #
We accept MCAT scores that are no more than three years old. To retrieve your sixteen-digit alphanumeric code, please
go to aamc.org/mcat, log in, and find the option to “print an official copy of my MCAT scores”, and enter that code above.
If English is not your first language, please provide your TOEFL score:
Month/Year
Have you previously applied to the Medical School for International Health?
☐ No
☐Yes in
Have you previously attended, or are you now attending another medical school?
☐Yes ☐No
If yes, dates attended:
to
Are you applying as a transfer student?
reviewed on a case-by-case basis.
Number of years of completed medical study:
☐Yes ☐No Transfer and credit of coursework is
Medical School attended:
School Name/ Country
I have received, or expect to receive before August 2016, the degree of
from
If you hold an advanced degree, please list the school(s) and date(s) of study:
School(s), Date(s) of study
Have you ever been suspended or placed on academic probation at any institution of higher learning?
☐No
☐ Yes If yes, indicate the date and reason:
Have you ever been convicted of a felony? ☐ No
☐Yes If yes, indicate the date and reason:
Essays
Please type answers in WORD, and name the file “first name last name ESSAYS”.
1. Please describe your education, skills, and/or experiences that are relevant to global health.
(no longer than one page, single spaced)
2. Please provide a biographical essay describing yourself. (3/4 page, single spaced)
3. What is the biggest challenge that you have faced to date? How did you handle it? In retrospect,
what would you or could you have done differently? (3/4 page, single spaced)
Prerequisite courses in progress at time of application
Applicants must have or expect to receive an undergraduate degree before entering MSIH. Your
coursework must include one year of biology, one year of physics, and two years of chemistry, one of
which must be organic chemistry with labs and lectures.
Please list the courses that you are currently taking or will complete before matriculation that are
required for admission. You must supply transcripts for all coursework.
Academic Year 20
Subject
to 20
College/University attended:
Course Title
Recommendations and Committee Letter
Does your college/university have a pre-medical committee? ☐Yes
☐ No
Have you requested a recommendation from your college pre-medical committee or advisor?
☐Yes ☐ No
If you will not have a committee letter, please list the names of at least three people who will submit
recommendations (you may submit additional recommendations if desired):
1.
2.
3.
How did you hear about us?
☐Website
☐Pre-health Advisor
☐ E-news ☐Blog
☐Professor ☐MSIH Alumni/Student
☐Campus visit
☐Conference ☐ Ad
☐News article ☐Brochure ☐Facebook
Application signature, fee and submission process
The admission and registration of the undersigned, if granted pursuant to this application, is subject to
all rules and provisions set forth by the university. I hereby certify that all information provided in my
application is truthful, accurate, and complete.
Signed:
Date:
Application checklist:
1. Complete the application and submit via email to msihadmissions@post.bgu.ac.il
2. Email a complete CV, with file name “your first and last name CV”
3. Email a photo, file name with your “first and last name PHOTO”
4. Email all three required essays, “file name with your first and last name ESSAYS”
4. Call the office at 212-995-1231 to provide a debit or credit card number for the $95.00 application
fee. Your application will not be processed until the fee is paid.
We accept transcripts and letters of recommendation sent to us via email from third party entities like
Interfolio. Please have transcripts and letters of recommendation sent via email to
msihadmissions@post.bgu.ac.il or by US Mail or overnight courier to:
Medical School for International Health
601 West 168th street, Suite 63
New York, NY 10032
Questions about the application process?
Please call the office at 212-995-1231 or email us at msihadmissions@post.bgu.ac.il