Alive in Kansas City. Apply online: APPLY NOW. to UMKC School of Medicine. Application for Six-Year B.A./M.D.

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1 Alive in Kansas City Apply online: APPLY NOW to UMKC School of Medicine Application for Six-Year B.A./M.D. Program MD Application08.indd 1 7/17/08 10:15:43 AM

2 Instructions for Admission to Baccalaureate M.D. Program Application checklist Detach and keep for your records * UMKC Application for Admission Complete the enclosed paper application (pages 3-6) or to expedite the process, apply online at Only one version of the application is needed. U.S. citizenship or permanent resident status by Nov. 1, 2008 is required of all applicants. If you are a permanent resident, a copy of the permanent resident card must accompany your application. * $35 nonrefundable application fee for Missouri residents * $50 nonrefundable application fee for non-missouri residents * School of Medicine Supplemental Application with essay and short answers (Pages 7-8) * High School Activity Sheet (Page 9) *School of Medicine Technical Standards (Page 13) * Official high school transcript with your class rank at the end of your junior year Meeting high school core is mandatory. Course requirements: four units of English, four units of math, three units of science, three units of social studies, one unit of fine arts and two units of a single foreign language. (one unit = one year in class) American College Test (ACT) scores and the ACT Student Profile (directly from testing agency) Out-of-state residents may submit SAT results; however the ACT is preferred. You are responsible for sending updated test scores to UMKC throughout the year. Three School of Medicine Reference forms (Pages 15-20) (These are submitted by teachers, counselors or school administrators directly). Mail your application, test results and all transcripts to: Office of Admissions University of Missouri-Kansas City 120 Administrative Center 5100 Rockhill Road Kansas City, MO An application cannot be reviewed for admission until all items listed have been received in the Office of Admissions. When all materials have been received in Admissions, they will be reviewed by the Council on Selection at the School of Medicine. Deadline for submission of application materials is Nov. 1, After the review of all applications by the School of Medicine s Council on Selection, applicants who appear to be well qualified will be invited to the University for an interview. If invited, you will be required to be present at the scheduled date and time of the interview. After all invited applicants have been interviewed, the Council on Selection will offer admission to those candidates who best qualify for the UMKC program. Applicants will be notified in writing of the decision. * To expedite the review of your application, complete the UMKC Application for Admission (click on the Freshman tab and select MED-UNDEC-Medicine MD- 6yr program ) and Supplemental Application online. Mail the test results, transcripts and remaining items together to the Office of Admissions address. Detach this page and keep for your records. Detach reference forms and distribute to teachers and counselors. Apply online: MD Application08.indd 2 7/17/08 10:15:44 AM

3 Degree Programs Some programs and degrees require special application for admission and have specific entry requirements. To find out more go to A&S College of Arts and Sciences BIO School of Biological Sciences BPA Henry W. Bloch School of Business and Public Administration CON Conservatory of Music DEN School of Dentistry EDU School of Education GRAD School of Graduate Studies LAW School of Law MED School of Medicine NUR School of Nursing PHA School of Pharmacy SCE School of Computing and Engineering Undergraduate Degree Programs Accounting (BPA) B.S American Studies (Interdepartmental) (A&S) B.A Architectural Studies (A&S) # Art (A&S) B.A Art History (A&S) B.A Biology (BIO) B.A., B.S *Bioinformatics * Cellular and Molecular Basis of Health and Disease **Pre-dentistry Business Administration (BPA) B.B.A *Accounting *Enterprise *Entrepreneurship *Finance *Management *Marketing Chemistry (A&S) B.A., B.S Communication Studies (A&S) B.A *Mass Communication *Speech Communication Computer Science (SCE) B.A., B.S *Bioinformatics Criminal Justice and Criminology (A&S) B.A Dance (CON) B.F.A Dental Hygiene (DEN) B.S.D.H Clinical and Classroom Teaching Clinical Practice (Fall semester admission only. Deadline is Feb. 1.) Economics (A&S) B.A Education (EDU) B.A (Special application packet required for all education majors.) Early Childhood Education B.A Elementary B.A Middle School B.A Secondary Education B.A *Art *English *Foreign Languages French, German, Spanish *Mathematics *Music *Natural Science Biology, Chemistry, Earth Science, Physics *Social Science Engineering (SCE) Civil Engineering B.S.Ci.E Electrical Computing Engineering B.S.E.E Mechanical Engineering B.S.M.E English (A&S) B.A *Creative Writing B.A *Secondary English Education Environmental Studies (A&S) B.A., B.S French (A&S) B.A Geography (A&S) B.A., B.S General Studies, undecided Geology (A&S) B.A., B.S German (A&S) B.A History (A&S) B.A Information Technology (SCE) B.I.T Liberal Arts (A&S) B.L.A Mathematics and Statistics (A&S) B.A., B.S **Applied Math and Statistics Medical Technology (BIO) B.S Medicine 6-Yr. Program (MED) B.S./M.D (Fall semester admission only. Application deadline is Nov. 15. Special application packet required.) Music (CON) B.A (UMKC application required along with supplemental application and audition for all music degrees.) *Music Therapy Music Composition (CON) B.M Music Education (CON) B.M.E *Choral *Instrumental *Music Therapy Music Performance (CON) B.M. *Bassoon *Cello *Clarinet *Euphonium *Flute *Guitar *Horn *Jazz and Studio Music *Oboe *Organ *Percussion *Piano *Piano Pedagogy *Saxophone *String Bass *Trombone *Trumpet *Tuba *Viola *Violin *Voice Music Theory (CON) B.M Nursing (NUR) R.N.-B.S.N Nursing (NUR) B.S.N Pharmaceutical Sciences B.S Pharmacy (PHA) Pharm.D (Fall semester admission only. Application deadline is Dec. 15. Provisional admission for high school students: Fall admission only. Deadline is Jan. 15. UMKC application and supplemental application materials required.) Philosophy (A&S) B.A Physics (A&S) B.A., B.S Political Science (A&S) B.A Psychology (A&S) B.A Sociology (A&S) B.A Spanish (A&S) B.A Studio Art (A&S) B.A *Graphic Design/Photography Theatre (A&S) B.A Urban Affairs (A&S) (Interdepartment) B.A Urban Planning and Design B.A Graduate Degree Programs College of Arts and Sciences Art History (A&S) M.A Chemistry (A&S) M.S (Fall semester application deadline is April 15. Spring semester deadline is Oct. 15.) *Analytical Chemistry *Inorganic Chemistry *Organic Chemistry *Physical Chemistry *Polymer Chemistry Criminal Justice and Criminology (A&S)M.S (Summer/Fall semester application deadline is April 1. Spring semester deadline is Nov. 1) Economics (A&S) M.A *Applied Economics English (A&S) M.A (Fall semester admission only. Application deadline is Feb. 15.) *Creative Writing Geosciences (A&S) Environmental & Urban Geosciences M.S Waste Management Certificate History (A&S) M.A (Fall semester application deadline is April 30. Spring semester deadline is Oct. 1.) Liberal Studies (A&S) M.A Mathematics and Statistics (A&S) M.A., M.S (Fall semester admission only. Application deadline is March 15.) Physics (A&S) M.S Political Science (A&S) M.A Psychology (A&S) Ph.D (Fall semester admission only. Application deadline for Ph.D. programs is Jan. 15.) # The Architectural Studies sequence is a cooperative program with Kansas State University. Students enroll at UMKC in preparation for admission to KSU, where they may be awarded degrees in architecture, landscape architecture and interior architecture. * Emphasis areas within degree programs that appear on transcripts, but not on diplomas. ** Concentrations within degree programs that do not appear on diploma or transcript. ***Separate admission application required; contact specific academic unit. 1 MD Application08.indd 3 7/17/08 10:15:44 AM

4 Romance Languages and Literature (A&S) M.A Social Work (A&S) M.S.W Gerontology Certificate Sociology (A&S) M.A Studio Art (A&S) M.A (Fall semester application deadline is March 1. Spring semester deadline is Oct. 1.) Theatre (A&S) M.A Theatre (A&S) M.F.A. *Acting *Design *Technology School of Biological Sciences Biology (BIO) M.A Cellular and Molecular Biology (BIO) M.S *Biochemistry *Bioinformatics Henry W. Bloch School of Business and Public Administration Accounting (BPA) M.S Business Administration (BPA) M.B.A. *Entrepreneurship *Finance *International Business *Leadership and Change in Human Systems *General Management *Management of Information Systems *Marketing *Operations Management Public Administration (BPA) M.P.A *Health Services Administration *Human Resources Management *Nonprofit Management *Organizational Behavior *Urban Administration School of Computing and Engineering Computer Science (SCE) M.S *Bioinformatics *Computer Networking *Software Engineering *Telecommunications Networking Engineering (SCE) Civil Engineering M.S Electrical Engineering M.S Mechanical Engineering M.S Conservatory of Music and Dance Music (CON) M.A (UMKC application required along with supplemental application and audition for all music degrees. Recommended deadline is Feb. 1.) *Music Therapy Music Composition (CON) M.M., D.M.A Music Conducting (CON) M.M., D.M.A Music Education (CON) M.M.E *Choral *Instrumental Music History and Literature (CON) M.M Music Performance (CON) M.M., D.M.A., or Certificate *Bassoon *Cello *Clarinet *Euphonium *Flute *Guitar *Horn *Oboe *Organ *Percussion *Piano *Piano Pedagogy *Saxophone *String Bass *Trombone *Trumpet *Tuba *Viola *Violin *Voice *Woodwinds M.M., Certificate Music Theory (CON) M.M School of Dentistry Dental (DEN) ***Advanced Education in General Dentistry (DEN) Certificate (Summer session admission only. Application deadline is Oct. 1.) Dental Hygiene Education (DEN) M.S *Research (Fall semester admission only. Application deadline is Feb. 1.) ***Dentistry D.D.S (Fall semester admission only. Application deadline is Nov. 1.) ***Endodontics (DEN) Certificate (Summer session only. Application deadline is Aug. 15.) ***Oral Biology (DEN) M.S ***Oral and Maxillofacial Surgery (DEN) Certificate (Summer session admission only. Application deadline is Aug. 15.) ***Oral and Maxillofacial Radiology Certificate ***Orthodontics and Dentofacial Certificate Orthopedics (DEN) (Summer session admission only. Application deadline is Sept. 5.) ***Pediatric Dentistry (DEN) Certificate (Summer session admission only. Application deadline is Oct. 15.) ***Periodontics (DEN) Certificate (Summer session admission only. Application deadline is Sept. 1.) School of Education Counseling and Guidance (EDU) (Application deadline is March 1 for Fall admission and Sept. 1 for Spring.) *Couples and Family Counseling M.A., Ed. Sp *Mental Health Counseling M.A., Ed. Sp *School Counseling and Guidance Ed. Sp *Elementary M.A *Secondary M.A Counseling Psychology Ph.D (Fall semester admission only. Application deadline is Jan 1. ) Curriculum and Instruction *General M.A *Curriculum Theory and Leadership Ed. Sp *Early Childhood M.A., Ed. Sp *Elementary M.A *Elementary or Middle School Specialty Ed. Sp *Multicultural Education M.A., Ed. Sp *Subject Specialty M.A., Ed. Sp *Teaching English as a Second Language M.A *Learning Technologies M.A Educational Administration *General M.A., Ed. Sp *Elementary School Admin. M.A., Ed. Sp *Higher Ed. Admin. M.A (Fall semester deadline is March 1. Spring semester deadline is Oct. 1.) *Secondary School Admin. M.A., Ed. Sp (Fall semester deadline is July 1. Winter semester deadline is Nov. 1. Summer session deadline is April 1.) *Doctorate in Education Administration Pre K-12 EdD (Application deadline is Aug. 1, 2007, for Winter 2008.) Reading Education (EDU) M.A., Ed. Sp Special Education (EDU) M.A School of Graduate Studies ***Interdisciplinary Leadership and Disability Studies (GRAD) Certificate ***Interdisciplinary Ph.D. Program (GRAD) Students select and earn a Ph.D. in two or more disciplines. Participating disciplines: Art History Cell Biology and Biophysics Chemistry Computing-Telecommunications and Networking Computing-Computer Science Computing-Computing and Electrical Engineering Curriculum and Instruction Economics Engineering English Entrepreneurship and Innovation Geosciences History Mathematics Molecular Biology and Biochemistry Music Education Oral Biology Pharmaceutical Sciences Pharmacology Physics Psychology Public Affairs and Administration Religious Studies Social Science Consortium Sociology Urban Leadership and Policy Studies in Education School of Law ***Law (LAW) L.L.M **Estate Planning **Urban, Land Use and Environmental Law **Litigation **Business and Entrpreneurial Law ***Juris Doctor (LAW) J.D ***Taxation (LAW) L.L.M ***Urban Affairs (LAW) L.L.M School of Medicine Medicine with Advanced Standing (MED) M.D (Spring semester admission only. Application deadline is Aug.1.) Anesthesiology (MED) M.S.A (Application deadline is Jan. 5.) School of Nursing Nursing (NUR) M.S.N (Application deadline is Feb. 1 for Fall admission and Sept. 1 for Spring.) Nursing Cooperative Programs (NUR) Ph.D (Application deadline is Feb. 1 for Fall admission only.) School of Pharmacy Pharmaceutical Sciences (PHA) M.S *Pharmaceutical Chemistry *Pharmacology *Toxicology (Application deadline is March 1.) Pharmacy (PHA) Pharm.D (Fall semester admission only. Application deadline is Jan. 15; special application packet required.) MD Application08.indd 4 7/17/08 10:15:44 AM

5 UMKC Application for Six-Year B.A./M.D. Program Office of Admissions University of Missouri-Kansas City 120 Administrative Center 5100 Rockhill Road Kansas City, MO Location Address: 5115 Oak St or UMKC (8652) FAX Ready to apply? Complete the online application available at or bring your application to room 120, in the UMKC Administrative Center at 5115 Oak St. or mail your application, test results and all transcripts to: University of Missouri-Kansas City, Office of Admissions, 120 Administrative Center, 5100 Rockhill Road, Kansas City, MO General instructions Please read these instructions and admissions criteria before completing this application. Please type or print. Applicants are encouraged to apply well before admissions deadlines. Refer to departments for special deadlines. Note special admissions packets and requirements for certain academic programs. Call the UMKC academic unit for complete information. All applications must be accompanied by a nonrefundable $35 application fee. A $50 application fee for nonresidents applying to the six-year B.A./M.D. program is also required. Applications can not be processed without fees. Please send checks or money orders only. Online applicants may pay by credit card. Applicants who do not meet admissions criteria may petition for admission by contacting the Office of Admissions. A 2.0 GPA on a 4.0 scale is required of all college-level coursework for freshman applicants who have completed college credit. Additional Information Refer to the Registration Guide and UMKC catalog for information on fees, refunds and class schedule changes. All transcripts submitted in support of an application become the property of UMKC. Freshman Admission Applicants for admission to Year 1 of the six-year medical program must first be accepted into UMKC. Admission is selective and is determined by a combination of class rank and ACT score, as well as completion of the following criteria: Graduation from an accredited United States high school with curriculum including: (one unit equals one year in class) four units of English four units of mathematics (algebra I or higher) three units of science, including one unit of biology and one unit of chemistry three units of social studies one unit of fine arts (visual arts, music, dance or theater) two units of the same foreign language one-half unit of a computer science course is recommended by the medical school. The school strongly encourages prospective students to earn credit through Advanced Placement (AP) courses, if available, in math, English, European history or American history. If your high school does not offer biology, chemistry or foreign language, contact the Council on Selection at the School of Medicine at or write to: Council on Selection, UMKC School of Medicine, 2411 Holmes, Kansas City, Mo U.S. citizenship or permanent resident status by Nov. 15 of the year preceding the fall term for which you are applying. A copy of the permanent resident card must accompany your application. Demonstration of ability to perform successfully at the college level, particularly in UMKC s six-year program, as evidenced by a combination of high school class rank, ACT score and completion of the ACT Student Profile Performance on the Toledo Chemistry Test (administered at time of interview) Personal characteristics such as self awareness; leadership and teamwork ability; time management and problem solving skills, life long learning; motivation; respect, compassion and empathy, communication skills and an understanding of diversity and social context. Submission of the Year 1 medical school application that includes a personal statement, activity sheet and letters of recommendation Missouri Residents The average accepted Missouri applicant has an ACT score of 29 and a rank within the top 10% of the graduating class Regional and Out-of-State Residents The average accepted regional or out-of-state applicant has an ACT score of 30 and a rank within the top 5% of the graduating class. Applicants With Some College Credit Students may apply after graduation from high school provided they have no more than 24 hours of post high school diploma college credit at the time their application is submitted to the Admissions Office. These applicants will be reviewed with the same criteria as other Year 1 applicants. If the applicant is currently enrolled in college the semester they apply to the six-year program, the number of hours accumulated at the end of that semester must not exceed the 24-hour limit. Applicants may continue in college the next semester while their application is being processed. Applicants must have a 3.0 GPA or higher for all college credit attempted or earned. Official college transcripts must be submitted along with other application materials. A current ACT test within the last three years is required. Applicants with more than 24 hours of college credit may qualify as an M.D.-only applicant. M.D.-Only Applicants Positions may become available between the second and third year of the program. Applications will be considered from both in-state and out-of-state residents who hold at least a baccalaureate degree. A minimum cumulative GPA of 3.0 is required. M.D.-only students enter the School of Medicine and begin their curriculum in the spring semester of Year 2 of the program. The application deadline for January entry into the M.D.-only program is Aug. 1 of the preceding year. A score of 24 or better on the MCAT is preferred. Based on the revised MCAT schedule effective January 2007, applicants are strongly encouraged to take the MCAT no later than June 15. Scores from later administrations may not be available in time to be considered for the following January admission. Applicants must have a minimum of 19 hours of chemistry that includes two semesters of general chemistry, one semester of organic chemistry and one semester of biochemistry (a 300 or 400-level course with a grade of B or above is required. Human biochemistry recommended, as a 300-level course or above). Students must also have a minimum of 14 hours of biology that includes one semester of general biology with lab, one semester of genetics and one semester of cell biology. M.D.- only applicants are also strongly encouraged to enroll in one semester of microbiology with lab and one semester of introductory anatomy with lab. Courses in physics and algebra/ calculus are also strongly encouraged. 3 MD Application08.indd 5 7/17/08 10:15:44 AM

6 UMKC Application for Six-Year B.A./M.D. Program Report of Required High School Coursework Apply online at New freshmen and transfer students with fewer than 24 hours of college-level coursework must complete this form. Last name First Middle Social Security number High school name Phone number High school address City State ZIP Required subject areas and typical examples You are encouraged to consult your counselor to determine which courses to list in each area. Completed coursework Enter the names of the courses completed. One unit = one year in class Grade Units Coursework in progress Enter the names of all other courses to be completed before graduation. Units Four units of English (One may be in speech or debate; two that emphasize composition or writing skills are required.) English 9, 10, 11, 12; English literature, speech, debate, journalism, etc. Not acceptable: yearbook, acting, theater, drama, business English, media Four units of mathematics algebra I, geometry, algebra II, pre-calculus/trigonometry/analytic geometry, calculus, math analysis, etc. Not acceptable: computer math, programming, consumer math, prealgebra, accounting, basic math, technical math, computer science Three units of science (One unit of biology and chemistry is required. One unit must be a laboratory course.) earth science, physics, etc. Not acceptable: general science, vo-ag or agricultural science Three units of social studies world history, American history, American government, principles of democracy, etc. One unit of fine arts art, music, drama, dance. Not acceptable: allied arts, literature, foreign language, speech, debate Two units of a single foreign language This requirement may be satisfied by the completion of courses in middle school, junior high or senior high; or by a passing score on a proficiency examination. 4 MD Application08.indd 6 7/17/08 10:15:44 AM

7 UMKC Application for Six-Year B.A./M.D. Program Print or type information. Apply online at General information m Midwest Student Exchange Program Social Security number Last name First Middle Other (Maiden) Current legal address: number and street City State ZIP County Current mailing address: number and street City State ZIP County Home phone Cell phone Work phone Date of birth: month/day/year address Any student under age 21 and financially dependent on a parent or guardian must complete the following: Mother s name Address City State ZIP Father s name Address City State ZIP Residency information Are you a Missouri resident? m Yes m No Place of birth: City How long have you been a Missouri resident? State Previous Legal Address, if less than one year in Missouri: City County State Are you a legal resident of Johnson, Leavenworth, Miami or Wyandotte county in Kansas? m No m Yes, how long? Are you a U.S. citizen? m Yes m No, country of citizenship If resident alien, card number Date of issue Attach a copy of your card. Note: If you are an international visa student (nonresident alien), do not use this form. Enrollment information Have you ever applied to UMKC before? m No m Yes, semester and year applied: Have you previously enrolled at UMKC? m No m Yes, last semester enrolled: Which semester and year will you enter UMKC? m Fall 20 m Spring 20 m Summer 20 What will be your entering status? m New freshman m Transfer m Graduate m Second-degree-seeking (undergraduate post-bachelor) m Nondegree-seeking (nondegree-seeking students are not eligible to receive financial aid) Do you plan to complete a degree at UMKC? m Yes m No Briefly describe your educational goals: Optional information Gender and ethnic origin are requested for purposes of federal compliance reporting. Gender: m Male m Female Ethnic Origin: m American Indian or Native Alaskan m Asian m White, Non-Hispanic m Black, Non-Hispanic m Hispanic or Latino m Native Hawaiian or other Pacific Islander Are you or your parents employed by the University of Missouri? m Yes m No Did one or both of your parents graduate from college? m Yes m No Did one or both of your parents/grandparents graduate from UMKC? m No m Yes, name: First Last (Maiden) Religious preference (Not combined with federal compliance. May be sent to campus ministry organizations.) Educational information High school attended City State Date of (anticipated) graduation or GED diploma GED score xx continued on other side 5 MD Application08.indd 7 7/17/08 10:15:44 AM

8 UMKC Application for Six-Year B.A./M.D. Program Educational information, continued Name and location of all colleges and universities attended prior to enrollment at UMKC, including dates of attendance and degrees earned or expected. Include all colleges or universities from which you have earned dual credit. Please request all colleges and universities send official transcripts of coursework. Failure to indicate schools in which you have been enrolled will void your admission. Attach list if necessary. Name of school Location Dates of attendance Degree earned/anticipated Freshman and transfer students (with fewer than 24 hours): Have you taken the ACT? m Yes m No If yes, have you requested your score to be sent to UMKC? m Yes m No Selecting a major, degree program and school All students should refer to the UMKC Degree Programs List and carefully select the appropriate program as listed. We only offer degrees in those programs on the list. If you don t select from the list of degrees, you will be placed in the program that corresponds with your educational goals and qualifications. Intended academic major and six-digit code: Baccalaureate M.D. Program If not admitted to the Baccalaureate M.D. Program program indicate your second choice of degree program, choosing from the list on pages 1 and 2: Students may also complete a Pre-Medicine track at UMKC to prepare for a more traditional medical program. If you are interested in Pre-Medicine as your second option for a degree track, check your choice below. Biology Pre-Medicine (School of Biological Sciences) Pre-Medicine/Health Programs (College of Arts and Sciences) indicate major: Other: Read carefully: I certify the information on this application is accurate and complete, and I understand that all required credentials must be submitted before an admission decision can be made. I authorize the University of Missouri-Kansas City to maintain all my records under my signed name, and I understand these records and credentials in support of my application are the property of UMKC and may not be returned or reproduced. Date Signature 6 MD Application08.indd 8 7/17/08 10:15:44 AM

9 Supplemental Application Form Year 1 Applicant information (please print or type) First time applying Re-applying Social Security number Last name First Middle Other Home phone Work phone Cell phone Current legal address: number and street City State ZIP County Current mailing address: number and street City State ZIP County Date of birth Birth country Are you a Missouri resident? Yes No Place of birth City State County How long have you been a Missouri resident? Are you a U.S. citizen? Yes No If no, country of citizenship If resident alien, card number Date of issue Attach a copy of your card. Note: If you are an international visa student (nonresident alien), do not use this form. Applicants must have at least three references and no more than six. Referee name Title address Phone number How did you find out about the combined Baccalaureate-M.D. program at UMKC? Please check as many as apply: Brochure Students at other medical schools Medical students at UMKC UMKC Medical School alumni Family physicians Family friend Internet Family member was/is in program (sibling, cousin, parent, etc.) High school counselors Other please explain Educational information High school name Year of graduation High school city and state High school phone number Are you currently enrolled as a freshman in college? Yes No If yes, where? Have you taken courses for college credit? If so, fill in the boxes below: Course name Number of credit hrs. AP (Advanced credit) IB (International baccalaureate Dual Credit (example) English X Other college credit Are you interested in being considered for a scholarship? (requires that applicant complete a FAFSA Free application for federal student aid). Yes No (continued on back) 7 MD Application08.indd 9 7/17/08 10:15:44 AM

10 Supplemental Application Form Year 1 Educational information (continued) What is the highest level of formal education obtained by your parents? (Mark with an X in the appropriate space.) Father Mother Father s name Grade school or less Some high school Occupation High school graduate Some college Mother s name College degree Post-graduate Occupation Number of sisters Number of brothers Ages Ages E-Consent E-Consent for School of Medicine Selection process gives permission for the UMKC School of Medicine Office of Selection to exchange s with you regarding person specific information. You have the right to receive your information in printed format. However, with your e-consent, your transactions can be processed faster than if you have to wait for mail from our offices or conduct business in person. The choice is yours. You must read and agree to the following information and conditions in order to complete the UMKC School of Medicine e-consent process. You may withdraw your e-consent at any time by sending a request to the UMKC School of Medicine Office of Selection, 2411 Holmes St., Kansas City, MO If you do not consent, you should know that: All correspondence will be sent through the U. S. Postal Service, which may delay processing. No exchanges between you and staff the School of Medicine Office of Selection will be considered offical. Even if you designate someone as authorized to access your information, no exchanges between them and staff in the School of Medicine Office of Selection will be considered official. All requests must be made in writing or in person. If your mailing address is not kept current with the University, you may experience significant delays. Please check one and sign below I give my e-consent for the address confirmed here (must match on previous page) I do not give my e-consent Date Signature 8 MD Application08.indd 10 7/17/08 10:15:45 AM

11 Print or type information. Personal statement What has motivated you to study medicine? Why do you think the UMKC School of Medicine should choose you? (Limit response to 500 words or less.) Additional short answer responses What is your greatest strength? What is your greatest weakness? How would these affect your ability to succeed in medical school?: Describe a time when you disagreed with a grade or evaluation. What did you do and why?: Describe a time when you were in group conflict. What was the problem and how did you handle it?: Describe an experience in which you interacted with people who are different from you. What did you learn from it/them?: What books have you read for interest/pleasure recently and why?: Medicine is defined as a field of life-long learning. What does this mean to you?: 9 MD Application08.indd 11 7/17/08 10:15:45 AM

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13 High School Activity Sheet Print or type information. Social Security number Last name First Middle Other Name of activity (please do not use acronyms) Dates of participation Hours/week devoted to activity Type of activity School related Community related (church etc.) Volunteerism Health care/shadowing experience Work experience Description of involvment in activity: Leadership role, if any: What and who motivates you to be involved in this activity? How do you think this activity prepared you for medical school? Name of activity (please do not use acronyms) Dates of participation Hours/week devoted to activity Type of activity School related Community related (church etc.) Volunteerism Health care/shadowing experience Work experience Description of involvment in activity: Leadership role, if any: What and who motivates you to be involved in this activity? How do you think this activity prepared you for medical school? Name of activity (please do not use acronyms) Dates of participation Hours/week devoted to activity Type of activity School related Community related (church etc.) Volunteerism Health care/shadowing experience Work experience Description of involvment in activity: Leadership role, if any: What and who motivates you to be involved in this activity? How do you think this activity prepared you for medical school? Return completed form with your application. (Copy as needed up to four times for a total of no more than 15 activities.) 11 MD Application08.indd 13 7/17/08 10:15:45 AM

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15 Te c h n i c a l Sta n da r d s This form must be completed and returned to the UMKC Office of Admissions, 120 Administrative Center, 5100 Rockhill Road, Kansas City, MO before your application will be reviewed further. The deadline for our receipt of this form is Nov. 1, Social Security number Last name First Middle Other Because of our obligation to ensure that patients receive the best medical care possible, certain abilities are required of our students. All students of medicine must possess those intellectual, emotional and physical capabilities which are necessary to participate fully in the curriculum and which are essential to achieve the levels of competence required by the faculty. Candidates for the medical degree must be able to observe and perform a variety of procedures. Intact sensory and motor functioning is required for accurate observation and the competent performance of procedures. Candidates must be able to observe and evaluate a patient accurately, at a distance and close at hand. This necessitates the functional use of the senses of vision, hearing, touch and sometimes smell. A candidate must be able to communicate effectively, to hear and to observe patients in order to elicit information, describe changes in mood, activity and posture, and perceive nonverbal communications. The candidate must be able to communicate effectively in oral and written form. Candidates must have sufficient motor function to elicit information from patients by palpitation, auscultation, percussion and other diagnostic maneuvers. Problem solving is a critical cognitive skill demanded of physicians, and it requires the intellectual abilities of measurement, calculation, reasoning, analysis and synthesis. In addition to these skills, a candidate must possess the high moral and ethical standards demanded of physicians and the emotional health required for full utilization of his or her intellectual abilities, the exercise of good judgment, the prompt completion of all responsibilities attendant to the diagnosis and care of patients, and the development of mature, sensitive and effective relationships with patients. Because of the above essential functions, the School of Medicine strongly discourages the use of surrogates to perform these functions as a reasonable accommodation for persons with disabilities. While each application is reviewed individually, it is necessary that each degree candidate himself or herself be able to observe and perform each task required by the curriculum of the school. Similarly, the school does not consider the waiver of required examinations a reasonable accommodation for individuals with learning disabilities. Learning-disabled students, when appropriate,* may be granted additional time on required examinations, be examined in separate testing facilities or accommodated in other reasonable ways, but they will not be exempted from the requirement to take and pass such examinations. The University of Missouri-Kansas City School of Medicine has a standing committee to review qualified applicants who are unable to meet the technical standards for admission as stated above. The entire application file will be formally reviewed by this standing committee of the Council on Selection in consultation with the UMKC Office of Disabled Student Services. *Contact the UMKC Office of Disabled Student Services for information regarding definition and documentation of learning disabilities. I have read and understand the above technical standards, and I hereby certify that I believe that I am able to meet these standards if I become a medical student at the University of Missouri-Kansas City School of Medicine. CHECK ONE: m Yes m No Date Signature 13 MD Application08.indd 15 7/17/08 10:15:45 AM

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17 Reference Form UMKC School of Medicine Baccalaureate-M.D. Degree Program Office of Admissions University of Missouri-Kansas City 120 Administrative Center 5100 Rockhill Road Kansas City, MO Location Address: 5115 Oak St or UMKC (8652) FAX APPLICANT: You are required to submit three references from teachers of academic subjects, counselors or school administrators who can inform us as thoroughly as possible on your academic and personal qualities and achievements as a total person. All references are to be submitted using this form. Please complete the top portion of the form, then give it to your referee for completion. I waive the right to inspect this confidential recommendation. I understand that, according to the Family Educational Rights and Privacy Act of 1974, this waiver is optional. Social Security number Last name First Middle Other Date of birth Home phone Work phone Cell phone Detach and give to teacher/counselor Signature of applicant Date Print name of referee REFEREE: The information supplied on this form will be used for the purpose of assessing the applicant s qualifications for admission. Your comments will be held completely confidential if the applicant has signed the statement above. The deadline for accepting these references is Nov. 1, Please mail this form directly to: Office of Admissions, University of Missouri-Kansas City, 120 Administrative Center, 5100 Rockhill Road, Kansas City, MO How long have you known the applicant? Years Months In what capacity? (indicate subject matter if teacher) 2. Do you know of anything that reflects adversely on the applicant s moral character? If so, please explain: (Attach a separate sheet if desired.) 3. Do you know of any emotional difficulties experienced by the applicant? 4. Do you feel that the applicant would be able to adjust to the demands of an intensive year-round educational program without undue difficulty? If not, please explain: The UMKC School of Medicine s combined Baccalaureate M.D. Degree is a unique program. If you are not familiar with our program, visit our Web site at 15 MD Application08.indd 17 7/17/08 10:15:46 AM

18 5. Please rate the applicant s achievement and potential by entering an X in the appropriate spaces below, comparing the applicant with others in his or her class and age group: Self awareness Responds well to criticism Self awareness Tolerance of anxiety Self awareness Knows own strengths and weaknesses Leadership and teamwork Ability to work with others Time management Organization and use of time Diversity and social context Openess to people different from themselves Diversity and social context Toleration of opposing views Respect, compassion and empathy Willingness to put the legitimate needs of others ahead of their own personal needs Respect, compassion and empathy Oriented to serving other people instead of oneself Problem solving Ability to make decisions Problem solving Ability to resolve conflict Problem solving General resourcefulness Life long learning Time spent in self education Life long learning General curiosity Motivation Commitment to career in medicine Communication skills Effective expression of thoughts and abilities Communication skills Ability to listen attentively Knowledge of the sciences Outstanding Above average Average Below average No knowlege 6. If you wish to add any comments, please use this space: 7. Please check one: m Recommend enthusiastically m Recommend m Recommend with reservations m Do not recommend Print name: Signature: Date: Institution: Position: 16 MD Application08.indd 18 7/17/08 10:15:46 AM

19 Reference Form UMKC School of Medicine Baccalaureate-M.D. Degree Program Office of Admissions University of Missouri-Kansas City 120 Administrative Center 5100 Rockhill Road Kansas City, MO Location Address: 5115 Oak St or UMKC (8652) FAX APPLICANT: You are required to submit three references from teachers of academic subjects, counselors or school administrators who can inform us as thoroughly as possible on your academic and personal qualities and achievements as a total person. All references are to be submitted using this form. Please complete the top portion of the form, then give it to your referee for completion. I waive the right to inspect this confidential recommendation. I understand that, according to the Family Educational Rights and Privacy Act of 1974, this waiver is optional. Social Security number Last name First Middle Other Date of birth Home phone Work phone Cell phone Detach and give to teacher/counselor Signature of applicant Date Print name of referee REFEREE: The information supplied on this form will be used for the purpose of assessing the applicant s qualifications for admission. Your comments will be held completely confidential if the applicant has signed the statement above. The deadline for accepting these references is Nov. 1, Please mail this form directly to: Office of Admissions, University of Missouri-Kansas City, 120 Administrative Center, 5100 Rockhill Road, Kansas City, MO How long have you known the applicant? Years Months In what capacity? (indicate subject matter if teacher) 2. Do you know of anything that reflects adversely on the applicant s moral character? If so, please explain: (Attach a separate sheet if desired.) 3. Do you know of any emotional difficulties experienced by the applicant? 4. Do you feel that the applicant would be able to adjust to the demands of an intensive year-round educational program without undue difficulty? If not, please explain: The UMKC School of Medicine s combined Baccalaureate M.D. Degree is a unique program. If you are not familiar with our program, visit our Web site at 17 MD Application08.indd 19 7/17/08 10:15:46 AM

20 5. Please rate the applicant s achievement and potential by entering an X in the appropriate spaces below, comparing the applicant with others in his or her class and age group: Self awareness Responds well to criticism Self awareness Tolerance of anxiety Self awareness Knows own strengths and weaknesses Leadership and teamwork Ability to work with others Time management Organization and use of time Diversity and social context Openess to people different from themselves Diversity and social context Toleration of opposing views Respect, compassion and empathy Willingness to put the legitimate needs of others ahead of their own personal needs Respect, compassion and empathy Oriented to serving other people instead of oneself Problem solving Ability to make decisions Problem solving Ability to resolve conflict Problem solving General resourcefulness Life long learning Time spent in self education Life long learning General curiosity Motivation Commitment to career in medicine Communication skills Effective expression of thoughts and abilities Communication skills Ability to listen attentively Knowledge of the sciences Outstanding Above average Average Below average No knowlege 6. If you wish to add any comments, please use this space: 7. Please check one: m Recommend enthusiastically m Recommend m Recommend with reservations m Do not recommend Print name: Signature: Date: Institution: Position: 18 MD Application08.indd 20 7/17/08 10:15:47 AM

21 Reference Form UMKC School of Medicine Baccalaureate-M.D. Degree Program Office of Admissions University of Missouri-Kansas City 120 Administrative Center 5100 Rockhill Road Kansas City, MO Location Address: 5115 Oak St or UMKC (8652) FAX APPLICANT: You are required to submit three references from teachers of academic subjects, counselors or school administrators who can inform us as thoroughly as possible on your academic and personal qualities and achievements as a total person. All references are to be submitted using this form. Please complete the top portion of the form, then give it to your referee for completion. I waive the right to inspect this confidential recommendation. I understand that, according to the Family Educational Rights and Privacy Act of 1974, this waiver is optional. Social Security number Last name First Middle Other Date of birth Home phone Work phone Cell phone Detach and give to teacher/counselor Signature of applicant Date Print name of referee REFEREE: The information supplied on this form will be used for the purpose of assessing the applicant s qualifications for admission. Your comments will be held completely confidential if the applicant has signed the statement above. The deadline for accepting these references is Nov. 1, Please mail this form directly to: Office of Admissions, University of Missouri-Kansas City, 120 Administrative Center, 5100 Rockhill Road, Kansas City, MO How long have you known the applicant? Years Months In what capacity? (indicate subject matter if teacher) 2. Do you know of anything that reflects adversely on the applicant s moral character? If so, please explain: (Attach a separate sheet if desired.) 3. Do you know of any emotional difficulties experienced by the applicant? 4. Do you feel that the applicant would be able to adjust to the demands of an intensive year-round educational program without undue difficulty? If not, please explain: The UMKC School of Medicine s combined Baccalaureate M.D. Degree is a unique program. If you are not familiar with our program, visit our Web site at 19 MD Application08.indd 21 7/17/08 10:15:47 AM

22 5. Please rate the applicant s achievement and potential by entering an X in the appropriate spaces below, comparing the applicant with others in his or her class and age group: Self awareness Responds well to criticism Self awareness Tolerance of anxiety Self awareness Knows own strengths and weaknesses Leadership and teamwork Ability to work with others Time management Organization and use of time Diversity and social context Openess to people different from themselves Diversity and social context Toleration of opposing views Respect, compassion and empathy Willingness to put the legitimate needs of others ahead of their own personal needs Respect, compassion and empathy Oriented to serving other people instead of oneself Problem solving Ability to make decisions Problem solving Ability to resolve conflict Problem solving General resourcefulness Life long learning Time spent in self education Life long learning General curiosity Motivation Commitment to career in medicine Communication skills Effective expression of thoughts and abilities Communication skills Ability to listen attentively Knowledge of the sciences Outstanding Above average Average Below average No knowlege 6. If you wish to add any comments, please use this space: 7. Please check one: m Recommend enthusiastically m Recommend m Recommend with reservations m Do not recommend Print name: Signature: Date: Institution: Position: 20 MD Application08.indd 22 7/17/08 10:15:47 AM

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24 Important Contacts Admissions or UMKC (8652) Bookstore Career Services Cashier s Office cashiers Campus Tours UMKC or UMKC (8652) Campus Information Events Hotline Financial Aid and Scholarships or UMKC (8652) On-campus Housing Information Student Life Welcome Center UMKC or UMKC (8652) Class Scheduler Statement of Human Rights The Board of Curators and UMKC are committed to the policy of equal opportunity, regardless of race, color, creed, sex, age, national origin, disability, or Vietnam-era Veteran status. The Affirmative Action Office, 360 Administrative Center, 5115 Oak St., is responsible for all relevant programs. Call for information or go to People with speech or hearing impairments may contact the University by using Relay Missouri, (TT). Students Right to Know In accordance with Public Law , UMKC reports 73.1 percent of its first-time freshmen return the second year. The UMKC Police Department publishes an annual campus report on personal safety and crime statistics. The report includes statistics for the previous three years concerning reported crimes that occurred on campus; in certain off-campus buildings owned or controlled by UMKC; and on public property within, or immediately adjacent to and accessible from the campus. The report also includes institutional policies concerning campus security, such as policies concerning alcohol and drug use, crime prevention, the reporting of crimes, sexual assault and other matters. The report is available at the UMKC Police Department, room 213, 4825 Troost Building, or online at www. umkc.edu/safetyreport. University of Missouri-Kansas City Office of Admissions 120 Administrative Center 5100 Rockhill Road Kansas City, MO or UMKC (8652) admit@umkc.edu an equal opportunity/affirmative action institution MD Application08.indd 24 7/17/08 10:15:49 AM