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PERSONAL INFORMATION SHEET FOR PRE-PROFESSIONALS

Instructions: Block and copy this document into a word processing program. TYPE in the required information. Be certain to sign and date the signature box. Print the document. Bring the signed copy to the Biology Office JSC 115 or mail it to Dr. Lori Hensley, Chair, HPAC, OBU Box 3696, Arkadelphia, AR 71998-0001. No recommendations will be written until the signed permission form has been received. Send an electronic copy to [email protected]. Delete these instructions from your submitted copy.

 

name                                                                OBU Box # or off-campus mailing address

 

email address                                                  phone number(s)

 

major(s)                                                           minor(s)

 

classification at the time of application(junior, senior, graduate):

 

graduation date

 

faculty advisor

 

applicant for: (Delete all options but your selection.)

 

_____  medical                        _____  medical technology

 

____­­_  dental                          _____  dental hygienist

 

_____  nursing                        _____  pharmacy

 

_____  optometry                    _____  veterinary

 

List all professional schools and addresses to which recommendations are to be sent.

 

 

 I do give permission for this material to be used in a confidential manner by the Health Professions Advisory Committee of Ouachita Baptist University, and I do waive the right of disclosure. SIGNATURE                                                                         DATE ­­­­­­­­­­­­­­­­­­­­­­­ 


 

Please complete this form being as specific as possible and indicate dates where appropriate:  The information is essential for the Health Professions Advisory Committee interview and evaluation.

 

1.   OBU organizations to which you belong and any office(s) held.

 

2.   Other leadership roles you have had while in college (either on or off campus).

 

3.   Honors and awards received while at Ouachita Baptist University.

 

4.   Relevant independent research, directed studies, field studies, or projects that you have engaged in while a student at Ouachita Baptist University.  Who was your supervisor?  If a publication resulted from your work, cite the reference.

 

5.   Medically related experiences.   Indicate the nature of the experience, with whom, where, how long, and the skills learned.

 

6.   List summer employment or jobs held during the academic year (other than those listed in 4 or 5).  Indicate the percentage of earned income used toward college expenses, if any.

 

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

 

8.   Any hobbies or other interests.

 

9.   Other activities outside the University that you consider relevant (for graduates, indicate activity/job after graduation).

 

10.  Other relevant information that you feel the Health Professions Advisory Committee

      should have that would aid in its evaluation of your potential for professional school. 

      (specific skills, interest areas, etc.)

 

11.  Compose a draft of the Personal Statement that you would include with your application.

 

 

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