Tarleton Health Professions Advisory Committee
Name:
(HPAC)
Date: 2/9/2016
BIOGRAPHICAL
FORM
All forms must be typed.
To complete Section XVI, you will need an official or unofficial transcript from each college you attended.
Sections 1-3 are for the HPAC. Keeping the HPAC apprised of changes to this information will prevent delays in your
evaluation process.
I. BACKGROUND INFORMATION
TSU student ID#:
telephone #:
e-mail:
If your are Pre-Med, -Dent, or -Vet and have registered with TMDSAS, what is you TMDSAS #:
From what high school did you graduate (include city and state)?
What was your rank in your high school graduating class?
What was your score on college entrance exams? SAT
ACT
When was your first semester at TSU?
Are you a degree-seeking student at TSU?
If yes, what is your major?
What is your concentration?
If a degree seeking student, in which semester and year do you expect to graduate?
What is your current GPA?
Science GPA (BIOL, CHEM, PHYS, MATH)?
How many hours did you complete in the semester of your heaviest course load?
Professional program to which you are applying:
If other, please specifiy:
I am applying to enter professional school in the fall of 20
.
Have you previously applied to professional school?
If yes, when?
Native language English?
U.S. citizen?
Ethnicity:
Other fluent languages:
If no, country of citizenship:
Have you completed a professional school admissions test?
Which exam?
If yes, when did you take this exam?
If no, when do you plan to take it?
If you completed a professional school admissions test, please enter your scores in the appropriate boxes below.
 MCAT: verbal reasoning
physical sciences
biological sciences
writing
 DAT: AC AVG
PAT
 PCAT: VERB
RCT
BIOL
 GRE: QUANT
VER
TOT
QRT
RC
CHEM
BIOL
GEN CHEM
MATH
TOT
ORG CHEM
TOTSCI
%TOT
Briefly describe how you prepared for or are planning to prepare for your professional school admission test.
Tarleton Health Professions Biographic Data Form
(2/9/2016) – Page 1 of 6
Tarleton Health Professions Advisory Committee
(HPAC)
II. COLLEGES, UNIVERSITIES, and PROFESSIONAL SCHOOLS
Indicate in all colleges/universities you have attended as well as applicable dates of attendance:
College
(Begin with the earliest)
Dates Attended
From
To
/
/
/
/
/
Degree Earned
(if yes, give date)
Major
(if applicable)
III. YOUR EVALUATORS (NOTE: This section not currently required, but would be helpful.)
Participants must solicit 3-5 letters of evaluation, including two from Tarleton professors.
Evaluator Name
Position
Relation to You
Sections IV-XIII mimic the TMDSAS application. Fill in each section thoroughly, but try to conserve words. Refer to the
sample document for examples and detailed instructions.
IV. ACADEMIC RECOGNITION
Describe any academic honors, awards, and other recognitions received since beginning college to the present.
Date
Activity/Honor
Description of Activity/Honor
Awarded
Tarleton Health Professions Biographic Data Form
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Tarleton Health Professions Advisory Committee
(HPAC)
V. LEADERSHIP EXPERIENCE
Describe any leadership roles or positions of responsibility held since beginning college to the present.
Role Title
Description of Responsibilities
(including “hours/week” and “hours total”)
Dates
From To
/
/
/
/
/
/
/
/
/
/
/
/
VI. RESEARCH EXPERIENCE
Describe any significant research activities you have participated in since beginning college.
Role Title
(include your responsibilities, “hours/week” and “hours total”)
Supervisor
Dates
From To
/
/
/
/
/
/
VII. HEALTHCARE RELATED EXPERIENCES
Any activity in which you worked with or observed patients or health professionals is “health care related.”
Describe any such experiences that you participated in since beginning college.
Activity
Description
(including “hours/week” and “hours total”)
Dates
From To
/
/
/
/
/
/
/
/
/
/
/
/
/
Tarleton Health Professions Biographic Data Form
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Tarleton Health Professions Advisory Committee
(HPAC)
VIII. COMMUNITY SERVICE
Describe any non-healthcare related community service or volunteer experience that you participated in since you
began college.
Activity
Description
(including “hours/week” and “hours total”)
Dates
From To
/
/
/
/
/
/
/
/
/
/
IX. EXTRACURRICULAR/LEISURE ACTIVITIES
Describe any extracurricular or leisure time activities to which you devoted significant time since you began college.
Activity
Description
(including “hours/week” and “hours total”)
Dates
From To
/
/
/
/
/
/
/
/
/
X. EMPLOYMENT EXPERIENCES
Describe any paid jobs that you have held since you began college.
Job Title
Where Employed and Responsibilities
(including “hours/week” and “hours total”)
Dates
From
To
/
/
/
/
/
/
/
/
/
/
Tarleton Health Professions Biographic Data Form
(2/9/2016) – Page 4 of 6
Tarleton Health Professions Advisory Committee
(HPAC)
XI. ACADEMIC DISHONESTY AND/OR CRIMINAL ACTIVITY
Describe any actions taken against you for academic dishonesty, conduct violations, criminal activity (including felony and/or
misdemeanor, other than minor traffic violations). Be as brief as possible while including relevant details and applicable dates.
XII. PERSONAL STATEMENT/APPLICATION ESSAY - required
This question mimics the TMDSAS Personal Statement Essay.
Explain your motivation to seek a career in
(field/discipline to which you are applying). Discuss your
philosophy of the profession and indicate your goals relevant to the profession. Limit your response to 5000 words
and attach to end of this Biographical Data Form.
XIII. UNIQUE LIFE EXPERIENCES - optional
This question mimics one of the TMDSAS Optional Essay prompts. Completing it is optional but recommended.
Briefly discuss any unique circumstances or life experiences that are relevant to your professional school
application which has not been previously presented. Limit your response to 2500 words and attach to end of this
Biographical Data Form.
XIV. PERSONAL CHARACTERISTICS FOR DIVERSITY - optional
This question mimics one of the TMDSAS Optional Essay prompts. Completing it is optional but recommended.
Describe any personal characteristics and/or important challenging experiences you have had that will contribute to
the diversity of or provide educational benefits to your fellow students. Limit your response to 2500 words and
attach at end of this Biographical Data Form.
Include your full
name, word count, and the date you submit the essay—each
edited version will have a different date.
Print your essays double-spaced, in 12-point font, and submit them along with your Biographical Form.
XV. OUT OF STATE APPLICATIONS
In 2009, the following sections appeared on AMCAS (for non-Texas MD schools) but not on TMDSAS.
 Military Service
 Publications

 Teaching or Tutoring
 Intercollegiate
Activities
 Conferences Attended
 Artistic Endeavors
 Presentations and
Posters
Personal Statement:
“Explain why you
want to go to medical
school,” 5300 chars
In 2009, the following sections appeared on AACOMAS (for non-Texas DO schools) but not on TMDSAS.
 Osteopathic
 Letter from DO
 Personal Statement:
Background
Recomnended
no prompt, 4500 chars
In 2009, the following sections appeared on AADSAS (for non-Texas dental schools) but not on TMDSAS.
 Personal Statement: “Discuss why you desire to enter a dentistry career and how a dental career meets your
personal and professional goals.” 4500 characters”.
XVI. TRANSCRIPTS
Attach unofficial or official transcrpits to the end of this document.
Tarleton Health Professions Biographic Data Form
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Name:
word count:
date:
word count:
date:
word count:
date:
Type essay prompt here.
Type or paste essay here.
Name:
Type essay prompt here.
Type or paste essay here.
Name:
Type essay prompt here.
Type or paste essay here.
Health Professions Biographical Form
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