Application for Admission with Advanced Standing (for Year 3)

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1 Application, nonrefundable application free, letters of evaluation, transcripts, and course descriptions must submitted to our office no later than February 1. This application should be completed in legible print and preferably in black ink. I. Identifying Information 1. Full Name: Application for Admission with Advanced Standing (for Year 3) Mr./ Mrs./Ms./Miss First Middle Last 2. Current Contact Information [Please notify us IMMEDIATELY of ANY CHANGE in this information.] Mailing Address: Street Address Apt. # City State Zip Telephone Number(s) (U.S.): Secondary: School of Medicine and Health Sciences Office of Admissions 2300 I Street, NW, Ste. 106 Washington, DC Phone: (202) Fax: (202) https://smhs.gwu.edu/academics/mdprogram/admissions/transfer 3. Permanent Legal Address: (if different from current information) Street Address Apt. # City State Zip 4. Sex: Male Female 5. Birthplace: Date: City County State 6. Citizenship: You must be a U.S. citizen, U.S. Permanent Resident, or a Canadian Citizen to be eligible to apply. Please check the appropriate box below to describe your status: U.S. Citizen U.S. Permanent Resident Canadian Citizen Optional: How would you describe yourself? American Indian, Alaskan Native or native Hawaiian Islander Asian or Pacific Islander Black, Non-Hispanic White, Non-Hispanic Hispanic Other 2016 Page 1

2 7. Were you ever the recipient of any institutional action by any college or medical school performance or conduct violation, even though such action may not have interrupted your enrollment or required you to withdraw? You must answer Yes even if the action does not appear on or has been deleted or expunged from your official transcripts due to institutional policy or personal petition. Yes No If yes, you must attach an explanation to this application. 8. Have you ever been convicted of, plead guilty, or plead no lo contendere (i.e. no contest, I do not wish to contend) to a criminal offense? Have you ever been arrested for a felony or misdemeanor? Yes No If yes, you must attach an explanation to this application. 9. Family background: Name Mother Father Guardian Occupation Highest level of education; name of institution and degree received, if any II. Educational Background 1. Secondary or preparatory school from which you graduated: Name Location Date 2. List chronologically every college, university, and professional school attended through the present. A bachelor s degree must have been completed at an accredited U.S. or Canadian institution to be eligible to apply. ALL INSTITUTIONS MUST BE REPORTED (INCLUDING SUMMER SCHOOLS), EVEN IF CREDIT WAS NOT EARNED OR DESIRED. Full Name of Institution Current Medical School: Location City and State From Mo.- Yr. To Mo.-Yr. Candidate for degree e.g., BA, MS, MD, non-degree, etc. If granted, give date. SCHOOL FROM WHICH YOU ARE TRANSFERRING MEDICAL COURSEWORK: Name: Are you currently in good standing with this program? If you are on leave you must be eligible to return Yes No *If no, you are not eligible to apply for Advanced Standing. 3. If you have previously applied for admission to GW Medical School? Yes No If yes, please list all application year(s): 2016 Page 2

3 4. Premedical course requirements: For each of the academic disciplines below, please list the U.S. or Canadian accredited college or university, course name and number, credit hours (in parentheses), and grade received. For specification of minimum requirements, refer to the Admissions Handbook and the information sheet. THIS MUST BE COMPLETED IN THE SPACE PROVIDED. Biology (8 hours minimum) Inorganic Chemistry (8 hours minimum) Organic Chemistry/Biochemistry (8 hours minimum) Physics (8 hours minimum) English (6 hours minimum) Social/Behavioral Sciences (3 hours minimum) 5. Please report your grades chronologically using the standard AMCAS (4.0 scale) grading system and semester hours; BCPM = biology, chemistry, physics, and math courses; AO = all other courses; PBUG = post-bac coursework. THIS MUST BE COMPLETED IN THE SPACE PROVIDED. BCPM AO TOTAL GPA Hours GPA Hours GPA Hours FR SO JR SR PBUG CUM UG GRAD (NOTE: #4 AND #5 MUST BE COMPLETED BY THE APPLICANT ON THIS APPLICATION; DO NOT WRITE SEE TRANSCRIPTS, ETC.) 6. Medical College Admissions Test (MCAT) Scores REQUIRED Exam Date: Series: VR PS BS Writing (if applicable) Exam Date: Series: VR PS BS Writing (if applicable) Exam Date: Series: Chemical and Physical Foundations Critical Analysis and Reasoning Biological and Biochem Foundations Psych, Soc and Bio Foundations 2016 Page 3

4 7. a. In chronological order, list your extracurricular activities, community service, etc., during and subsequent to your college years: b. If your education has not been continuous since high school, what have you done while not in school? In chronological order include employment or other activities in the space below. Please account for all non-academic time. III. Medical Education 1. You must attach a copy of your school s curriculum information. Also, please provide current transcript immediately. 2. USMLE Step I Scores A PASSING SCORE IS REQUIRED no later than April 1st I will be taking the exam on: (Planned Date) I have previously taken the exam: Date: Score: Date: Score: (Please report all scores.) 2016 Page 4

5 IV. Personal Statement A very small number of candidates for advanced standing are interviewed, use only the space below to give us information that you might choose to share during an interview. For example, you might want to describe special circumstances, your major experiences of the past few years, or your ultimate goals and commitments. V. Why are you applying to GW? 2016 Page 5

6 VI. Summary Recheck your application to see that all information is complete and correct. Please retain a copy of this completed application for your records. All questions must be answered. Incomplete applications will not be reviewed. Application, letters of evaluation, transcripts, transcript with medical coursework, and course descriptions may be submitted to our office by February 1. ALL application materials must be received by February 1. Applications are reviewed in the order they are received and completed. Applications that are incomplete after February 1 will not be reviewed. You will need to pay a non-refundable $125 application fee through our secure online payment gateway. Once your application is received by the office, you will receive instructions on completing the payment. Please note your application will not be considered complete until your payment is received. All applicants must provide a passing USMLE score. You must provide a passing score by no later than April 1. Please be sure you have indicated any planned test date. Only applicants in good standing and eligible to return to their program will be evaluated. I HEREBY CERTIFY THAT I PERSONALLY FILLED OUT THIS APPLICATION AND THAT THE INFORMATION IS TRUE, ACCURATE, AND COMPLETE, SO AS NOT TO BE MISLEADING. I AGREE TO PROPERLY ADVISE OF CHANGES IN THE INFORMATION PROVIDED. Applicant s Signature Date The submission of materially false or misleading information on an application form or in connection with the application process shall be grounds for rejection. If such a submission is discovered after entrance into the medical school or award of a degree, it shall be grounds for dismissal or for revocation of the degree. Mission & Vision The George Washington University School of Medicine and Health Sciences is dedicated to improving the health of our local, national, and global communities by: Educating a diverse workforce of tomorrow s leaders in medicine, science, and health sciences. Healing through innovative and compassionate care. Advancing biomedical, translational and health services delivery research with an emphasis on multidisciplinary collaboration. Promoting a culture of excellence through inclusion, service, and advocacy. As a globally recognized academic medical center, GW embraces the challenge of eliminating health disparities and transforming health care to enrich and improve the lives of those we serve. The George Washington University does not unlawfully discriminate against any person on the basis of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, or gender identity or expression. This policy covers all programs, services, policies, and procedures of the University, including admission to educational programs and employment. The University is also subject to the District of Columbia Human Rights Law. GW is committed to assisting all members of the GW community in providing for their own safety and security. The Annual Security and Fire Safety Report is available on the UPD website at If you would like to receive a booklet called "the Annual Security and Fire Safety Report" which contains this information, you can stop by the University Police Department at Rome Hall 101, nd Street, NW, Washington, DC, or you can request that a copy be mailed to you by calling (202) The website and booklet contain information regarding campus security and personal safety including such topics as: crime prevention, university police law enforcement authority, crime reporting policies, disciplinary procedures and other information related to safety and security on campus. They also contain information about crime statistics for the three previous calendar years concerning reported crimes that occurred on campus; in certain off-campus buildings or property owned or controlled by GW; and on public property within, or immediately adjacent to and accessible from the campus. This information is required by law and is provided by the George Washington University Police Department Page 6

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