Earlham College Health Services Advisory Committee

Earlham College Health Careers Advisory Committee

HEALTH CAREERS ADVISORY COMMITTEE APPLICATION

Fill in the requested information (A-G) and turn into the Health Services Secretary, Terry Shipley. You should also give the following items to each of the three faculty whom you are asking to write recommendations: A copy of this form (both sides), a copy of your transcript, and a copy of the letter requesting a recommendation. When the Health Careers Advisory Committee receives the three faculty letters,* we will write a composite letter of recommendation based on the faculty evaluations and also on Committee discussion. In the summer, when you tell us that a secondary application has been requested by a medical school, we will send this Committee recommendation. Should a medical school have its own form for recommendation we will adapt our procedure to suit their wishes.

In addition to the Committee recommendation you may, if you wish, request one or several letters from faculty members who know you well and are thoroughly familiar with your academic work. This person may be on the Health Careers Advisory Committee, but should not be one of the three faculty asked to write letters for us.

A.  NAME IN FULL ___________________________________________ SS _______________

     LOCAL ADDRESS ____________________________________________________________

     HOME ADDRESS _____________________________________________________________

     EMAIL ADDRESS (school and home) __________________________________________

      Health School application for entering class of Fall 20____.

B.   Three faculty members (one in a non-science area) who know you and your work

     well enough to write letters of recommendation.  If possible, do not include

     members of this Committee (Deibel, Harvey, Blair, Justus, Jurasek).

             NAME                                                DATE LETTER REQUIRED

      1.  ______________________________________________________  ________________

      2.  ______________________________________________________  ________________

      3.  ______________________________________________________  ________________

C.  Names of Health Schools to which you are applying:

      1.  ________________________________________________________________________

      2.  ________________________________________________________________________

      3.  ________________________________________________________________________

      4.  ________________________________________________________________________

      5.  ________________________________________________________________________

      6.  ________________________________________________________________________

                                                                                                     * by May 1 please .

        ETC.

D.  Academic Information

    Attach an unofficial transcript (or copy) of courses taken and grades received through fall

    term senior year.  Transfer students should submit transcripts from other schools as well.

E.  Extra-curricular Activities:

F.  Off-campus Experiences (Foreign Study, etc.)

G.  A well worded and thoughtful statement including reasons for choice of a career in health and

      professional objectives.  If you have participated in any health oriented job

      (hospital, clinical work) you may wish to mention them here.  You may wish to consult with

      Committee members about this essay.

       You may submit your AMCAS, AACOMAS, etc. essay if you wish.

Waiver of Right of Access to Committee Recommendation:

I hereby waive my right of access to this confidential Committee recommendation.

I understand I am not obligated to sign this waiver.  If you elect not to sign this waiver,

please consult with a Committee member.

Signed _____________________________________________________  Date _____________