Health Professions Information Form

Form must be submitted three days before scheduled interview date. No submitted form, no interview. Before you fill out the form, scroll to the bottom and make certain the submit button is present. Some browsers may not show the submit button. If so, change to another browser.

Information form for students to complete prior to interviewing with the student panel and the faculty Health Professions Advisory Committee.

Please don't fill out this input box.

First Name*

Last Name*

OBU ID#*

OBU Box#*

OBU Email*

Professional, Non-OBU Email*

Phone*

State of Residency *

Major(s)*

Minor(s)*

Classification*

GPA*

Expected graduation date*

Faculty Advisor*

Applicant for*

If you have not yet taken your professional exam (DAT, MCAT, etc), when are you are scheduled to take it?*

If you have taken your professional exam, what score did you earn, or when do you expect to receive your score?*

List all professional schools to which you are applying *

OBU organizations to which you belong and any offices held*

Other leadership roles you have had while in college either on campus or off

Honors and awards received while at OBU

Relevant independent research, directed studies, field studies, or projects in which you have engaged while a student at OBU. Who was your supervisor? Cite any publications that resulted.*

List medically related experiences, including shadowing. Indicate the nature of the experience, with whom, where, how many hours, date completed, and the skills learned.*

List summer employment and/or jobs held during the academic year (other than those listed above). Indicate the percentage of earned income used toward college expenses.

Is there anything that professional schools need to know for the interpretation of your credentials (illness, unusual personal situation, family death, finances, etc.)

Hobbies or other interests?

Other activities outside OBU that you consider relevant? (Graduates, indicate academic or job activity since graduation.)

Other relevant information the HPAC should know to aid its evaluation of your potential for professional school (special skills, etc.)

Write a personal statement addressing why you want to be a dentist, physician, OT, pharmacist, PA, PT, veterinarian, etc. and what brought you to the decision. Limit 5300 characters*