Application

What is your ethnic identity? Please check the appropriate selection(s).

African-American/Black	Mexican/Mexican-American/Chicano
American Indian or Alaskan Native	Pacific Islander (Micronesian/Polynesian/Pacific Isle)
Caucasian/White (Includes Middle Eastern)	Vietnamese/Vietnamese American
Chinese/Chinese American	Other Asian (Not including Middle Eastern)
East Indian/Pakistani	Other Spanish-American/Latino
Filipino/Filipino American	Decline to State
Japanese/Japanese-American	Others
Korean/Korean-American

Father/Legal Guardian's Name
Father's Work/Day Phone
Phone Number
Father's Occupation/Job Title
Mother/Legal Guardian's Name
Mother's Work/Day Phone
Phone Number
Mother's Occupation/Job Title
Family Size (including student)
Total Yearly Family Income
MaxFamilyIncome
I affirm

I affirm all information entered above is true and will provide documentation as requested.

We recommend that you complete the essay questions in a word document and copy and paste into the application. You cannot save the application and complete later and may get timed out.
1. Write a 250 word essay that convinces us you want to become a physician, and why this career choice is correct for you. (250 words max)
250
2. Please describe a time in the last year when you had to demonstrate your leadership or problem-solving abilities in an academic or extracurricular activity (e.g. student organization, class, sports team, volunteer group, church, etc.). (100 words max)
100
3. Describe any responsibilities or volunteer opportunities you have at home, school, church or in the community which relate to your career choice of becoming a physician. (100 word max)
100
4. Please list your top three extracurricular activities? These are any activities outside of school work that are most important to you or take most of your free time (job, sports, clubs, etc.) (20 words max)