Prehealth Evaluation Form

  • Student Evaluation

  • Please check off which evaluator(s) you are CURRENTLY adding to this form: (IMPORTANT: Do NOT check off evaluators you have already added to the form. That information has already been saved, and can be viewed by clicking 'next" at the bottom of the page.)

  • NOTE: You already entered information for Science Faculty 1 previously ({scienceFaculty}). Checking this box again will resend an email to this evaluator.

  • NOTE: You already entered information for Science Faculty 2 previously ({scienceFaculty28}). Checking this box again will resend an email to this evaluator.

  • NOTE: You already entered information for Social Science/Humanities Faculty previously ({socialSciencehumanities}). Checking this box again will resend an email to this evaluator.

  • NOTE: You already entered information for Evaluator documenting health care experience ({evaluatorName}). Checking this box again will resend an email to this evaluator.

  • NOTE: You already entered information for Optional Evaluator - confirming research previously ({evaluatorName43}). Checking this box again will resend an email to this evaluator.

  • NOTE: You already entered information for Optional Additional Evaluator previously ({evaluatorName48}). Checking this box again will resend an email to this evaluator.

  • NOTE: You already entered information for Optional Additional Evaluator 2 previously ({evaluatorName108}). Checking this box again will resend an email to this evaluator.

  • If you are not adding any evaluator(s) or changing any of your information at this time, do not check any of the options above. Press "next" to view the information you entered previously.

  • Student Information

  • Health Profession

  • Confidentiality Waiver

  • After careful consideration:*
    • Evaluator 1: A SCIENCE faculty who has taught you 

    • Evaluator 1: A SCIENCE faculty who has taught you

    • Evaluator 2: A SCIENCE faculty who has taught you 

    • Evaluator 2: A SCIENCE faculty who has taught you

    • Evaluator 3: A SOCIAL SCIENCE/HUMANITIES faculty who has taught you 

    • Evaluator 3: A SOCIAL SCIENCE/HUMANITIES faculty who has taught you

    • Evaluator 4: Documenting health care experience 

    • Evaluator 4: Documenting a minimum of 50 hours of health care experience

      Volunteer or paid work, shadowing/observation does not count for this requirement
    • Evaluator 5: OPTIONAL - confirming research 

    • Evaluator 5: OPTIONAL - confirming research

    • Evaluator 6: OPTIONAL 

    • Evaluator 6: OPTIONAL

    • Evaluator 7: OPTIONAL 

    • Evaluator 7: OPTIONAL

    • STUDENTS: Please click "submit" when you are finished filling out the above sections. An email will automatically be sent to the evaluators that you listed above.

    •  

  • {fullName3} should have already filled out Section A. Please complete section B.

  • Section A.

    Completed by the student.

  • Student Information

  • Health Profession

  • Student Confidentiality Waiver

  • After careful consideration:

  • Evaluator 1: A SCIENCE faculty who has taught you

  • Section B.

  • Science Evaluator 1

  • The student {fullName3} intends to apply to apply to the indicated area(s) of health professional schools. The purpose of this form is to gather information about the student which will assist the Pre-Health Committee in preparing a University evaluation.

  • NOTE: The information you supply shall be considered as CONFIDENTIAL, based on the student's decision above to waive his/her right to access the evaluation. Your comments are forwarded as part of the complete committee evaluation.

  • NOTE: The information you supply shall NOT be considered as CONFIDENTIAL, based on the student's decision above to NOT waive his/her right to access the evaluation. Your comments are forwarded as part of the complete committee evaluation.

  • How well do you know the applicant?*
  • To your knowledge, has there ever been any disciplinary action involving this student?*
  • What would be your attitude toward having this student in a position under your direction?*

  • Browse Files
    Cancelof
  • On the basis of your letter of recommendation, how do you rank him/her as a candidate:*

  • {fullName3} should have already filled out Section A. Please complete section B.

  • Section A.

    Completed by the student.

  • Student Information

  • Health Profession

  • Student Confidentiality Waiver

  • After careful consideration:

  • Evaluator 2: A SCIENCE faculty who has taught you

  • Section B.

  • Science Evaluator 2

  • The student {fullName3} intends to apply to apply to the indicated area(s) of health professional schools. The purpose of this form is to gather information about the student which will assist the Pre-Health Committee in preparing a University evaluation.

  • The information you supply shall be considered as CONFIDENTIAL, based on the student's decision above to waive his/her right to access the evaluation. Your comments are forwarded as part of the complete committee evaluation.

  • NOTE: The information you supply shall NOT be considered as CONFIDENTIAL, based on the student's decision above to NOT waive his/her right to access the evaluation. Your comments are forwarded as part of the complete committee evaluation.

  • How well do you know the applicant?*
  • To your knowledge, has there ever been any disciplinary action involving this student?*
  • What would be your attitude toward having this student in a position under your direction?*

  • Browse Files
    Cancelof
  • On the basis of your letter of recommendation, how do you rank him/her as a candidate:*

  • {fullName3} should have already filled out Section A. Please complete section B.

  • Section A.

    Completed by the student.

  • Student Information

  • Health Profession

  • Student Confidentiality Waiver

  • After careful consideration:

  • Evaluator 3: A Social Science/Humanities faculty who has taught you

  • Section B.

  • Social Science/Humanities Evaluator

  • The student {fullName3} intends to apply to apply to the indicated area(s) of health professional schools. The purpose of this form is to gather information about the student which will assist the Pre-Health Committee in preparing a University evaluation.

  • The information you supply shall be considered as CONFIDENTIAL, based on the student's decision above to waive his/her right to access the evaluation. Your comments are forwarded as part of the complete committee evaluation.

  • NOTE: The information you supply shall NOT be considered as CONFIDENTIAL, based on the student's decision above to NOT waive his/her right to access the evaluation. Your comments are forwarded as part of the complete committee evaluation.

  • How well do you know the applicant?*
  • To your knowledge, has there ever been any disciplinary action involving this student?*
  • What would be your attitude toward having this student in a position under your direction?*

  • Browse Files
    Cancelof
  • On the basis of your letter of recommendation, how do you rank him/her as a candidate:*

  • {fullName3} should have already filled out Section A. Please complete section B.

  • Section A

    Completed by the student.

  • Student Information

  • Health Profession

  • Student Confidentiality Waiver

  • After careful consideration:

  • Evaluator 4: Letter documenting a minimum of 50 hours of health care experience

  • Section B.

  • Evaluator

  • The student {fullName3} intends to apply to apply to the indicated area(s) of health professional schools. The purpose of this form is to gather information about the student which will assist the Pre-Health Committee in preparing a University evaluation.

  • The information you supply shall be considered as CONFIDENTIAL, based on the student's decision above to waive his/her right to access the evaluation. Your comments are forwarded as part of the complete committee evaluation.

  • NOTE: The information you supply shall NOT be considered as CONFIDENTIAL, based on the student's decision above to NOT waive his/her right to access the evaluation. Your comments are forwarded as part of the complete committee evaluation.

  • How well do you know the applicant?*
  • To your knowledge, has there ever been any disciplinary action involving this student?*
  • What would be your attitude toward having this student in a position under your direction?*

  • Browse Files
    Cancelof
  • On the basis of your letter of recommendation, how do you rank him/her as a candidate:*

  • {fullName3} should have already filled out Section A. Please complete section B.

  • Section A.

    Completed by the student.

  • Student Information

  • Health Profession

  • Student Confidentiality Waiver

  • After careful consideration:

  • Evaluator 5: OPTIONAL - letter confirming research

  • Section B.

  • Evaluator

  • The student {fullName3} intends to apply to apply to the indicated area(s) of health professional schools. The purpose of this form is to gather information about the student which will assist the Pre-Health Committee in preparing a University evaluation.

  • The information you supply shall be considered as CONFIDENTIAL, based on the student's decision above to waive his/her right to access the evaluation. Your comments are forwarded as part of the complete committee evaluation.

  • NOTE: The information you supply shall NOT be considered as CONFIDENTIAL, based on the student's decision above to NOT waive his/her right to access the evaluation. Your comments are forwarded as part of the complete committee evaluation.

  • How well do you know the applicant?*
  • To your knowledge, has there ever been any disciplinary action involving this student?*
  • What would be your attitude toward having this student in a position under your direction?*

  • Browse Files
    Cancelof
  • On the basis of your letter of recommendation, how do you rank him/her as a candidate:*

  • {fullName3} should have already filled out Section A. Please complete section B.

  • Section A.

    Completed by the student.

  • Student Information

  • Health Profession

  • Student Confidentiality Waiver

  • After careful consideration:

  • Evaluator 6: OPTIONAL

  • Section B.

  • Evaluator

  • The student {fullName3} intends to apply to apply to the indicated area(s) of health professional schools. The purpose of this form is to gather information about the student which will assist the Pre-Health Committee in preparing a University evaluation.

  • The information you supply shall be considered as CONFIDENTIAL, based on the student's decision above to waive his/her right to access the evaluation. Your comments are forwarded as part of the complete committee evaluation.

  • NOTE: The information you supply shall NOT be considered as CONFIDENTIAL, based on the student's decision above to NOT waive his/her right to access the evaluation. Your comments are forwarded as part of the complete committee evaluation.

  • How well do you know the applicant?*
  • To your knowledge, has there ever been any disciplinary action involving this student?*
  • What would be your attitude toward having this student in a position under your direction?*

  • Browse Files
    Cancelof
  • On the basis of your letter of recommendation, how do you rank him/her as a candidate:*

  • {fullName3} should have already filled out Section A. Please complete section B.

  • Section A.

    Completed by the student.

  • Student Information

  • Health Profession

  • Student Confidentiality Waiver

  • After careful consideration:

  • Evaluator 7: OPTIONAL

  • Section B.

  • Evaluator

  • The student {fullName3} intends to apply to apply to the indicated area(s) of health professional schools. The purpose of this form is to gather information about the student which will assist the Pre-Health Committee in preparing a University evaluation.

  • The information you supply shall be considered as CONFIDENTIAL, based on the student's decision above to waive his/her right to access the evaluation. Your comments are forwarded as part of the complete committee evaluation.

  • NOTE: The information you supply shall NOT be considered as CONFIDENTIAL, based on the student's decision above to NOT waive his/her right to access the evaluation. Your comments are forwarded as part of the complete committee evaluation.

  • How well do you know the applicant?*
  • To your knowledge, has there ever been any disciplinary action involving this student?*
  • What would be your attitude toward having this student in a position under your direction?*

  • Browse Files
    Cancelof
  • On the basis of your letter of recommendation, how do you rank him/her as a candidate:*

  • Should be Empty: