Instructions for application year 2017



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Intent To Apply Application
OVERVIEW AND INSTRUCTIONS FOR APPLICATION YEAR 2017
This application is your declaration to the Health Professions Advising Office (HPAO) and the Health Professions Committee that you intend to apply to health professional schools. Much of the information that you must provide will also be needed by you for your professional school application. This also assists the CSUF Health Professions Committee (HPC) in composing a meaningful letter on your behalf.
This application has been modified with permission from the HPO at Johns Hopkins University.
COMMITTEE LETTER ELIGIBILITY

To be eligible for a Committee Letter, (a) applicants must be or have been an undergraduate or Post Baccalaureate student of CSU Fullerton and (b) met the submission deadlines of the Intent To Apply process.


INSTRUCTIONS

First time applicants must complete every section of this application. Please keep the following points in mind:



  • Do not attach additional sheets for short answer questions. All responses must be written in the space provided.

  • Present your experience assuming that the reader has no familiarity with the site, setting, or organization to which you are referring, spell out names if acronyms are used, describe the nature and purpose of the experience, etc.

  • Consider your narratives as clear, concise, resume entries, with an organized flow from beginning to end: (a) be sure the reader understands the context or affiliation; (b) be sure you clearly describe what you did, what you accomplished, and/or how your experience evolved; and (c) if there was a “take away” from the experience, a definitive learning moment, you should mention it.


FEES

A $20 fee per professional program for current students and recent alumni (graduated less than one year). A $100 fee to apply to multiple professional programs for alumni who graduated more than one year ago. File fees can only be paid through the Health Professions Advising website or at the Student Financial Services (SFS) Window (UH-180). An additional form is required if you wish to pay your file fee at SFS. Please visit the following website to download the form: http://www.fullerton.edu/health_professions/applicationprocess/intent/FeePayment.asp. Please note, fee payments cannot be applied to future application cycles.


IMPORTANT FEE NOTICE: The $20 fee per profession will provide one upload to a professional school application service. A $25 fee is required for any additional upload/mailing to a Caribbean school. All other additional uploads which may consist of uploading/mailing a committee/letter packet, update to an applicant’s list of schools, and/or individual letter uploads, will require a fee of $20 each. Please plan accordingly, as to which schools you would like to apply to, as this will prevent additional upload fees.

REQUIRED DOCUMENTS FOR COMMITTEE LETTER

Material can be submitted via email to ItoA@fullerton.edu, uploaded to TITANium or delivered to UH-223 by 8 AM on Monday, February 27, 2017. Late submissions will not be accepted.



  • Intent to Apply application (ItoA) (.doc, .docx or .pdf)

  • Resume (.doc or .docx)

  • Unofficial transcripts from every higher education institution you attended unless courses are listed on another transcript that you plan to submit; PDF documents only.

  • At least one (1) letter of evaluation (LOE’s), signed, dated and on letterhead from a health professional.

    • Please note that additional letters of evaluation can be submitted after the February 27th deadline to be eventually included in your committee packet.

  • Fee Payment

  • 50 documented hours in a CCE program or similar program (An email from the program or shadowing experience will work as proof)

  • Digital photograph (JPG file- low resolution)


Supplemental Material – Items below must be received by our office before we will upload/mail your committee packet to the programs to which you have applied.

  • Professional school application

  • Additional LOEs indicated on ItoA application

  • List of Schools (Please provide the document available on our website if the list of schools you applied to does not appear on your professional school application. Note that the list of schools you provide to our office is final, as a result, you should submit only one list per profession. Do not approve an upload if you plan to make revisions to your list of schools.)

  • Please provide an upload date once everything has been submitted. This will be the date on which we will upload/mail your committee packet to the programs to which you have applied.


Please Note: The goal is to upload your packet is July 31, 2017.
REQUIRED DOCUMENTS FOR LETTER PACKET

Material can be submitted via email to ItoA@fullerton.edu, uploaded to TITANium or delivered to UH-223.



  • Submit your Intent to Apply Application (only pages 3-6 and the last three pages of the application)

  • All letters of evaluation noted on your intent to apply application

  • Digital photograph (JPG file-low resolution)

  • Fee payment

  • Professional school application

  • List of Schools (Please provide the document available on our website if the list of schools you applied to does not appear on your professional school application. Note that the list of schools you provide to our office is final, as a result, you should submit only one list per profession. Do not approve an upload if you plan to make revisions to your list of schools.)

  • Please provide an upload date once everything has been submitted. This will be the date on which we will upload/mail your committee packet to the programs to which you have applied.


Please Note: There is no deadline associated with a letter packet but students are still encouraged to submit their materials as soon as possible.
TITANIUM

Students can be added to the Health Professions TITANium community site prior to the submission of their ItoA application. To be added to the community site, please email ItoA@fullerton.edu with your full name and CSUF student email address. Once this information has been received, students will be added to the site in about 2-3 business days.


Intent To Apply Application
APPLICATION YEAR 2017


Please enter your answers into the form fields provided below. You may direct any questions to ItoA@fullerton.edu.




I. PERSONAL DATA




First Name:

      

Middle Name:

     

Last Name:

     

Nickname:

      

Gender:

      

Birthdate:

      

(MM/DD/YYYY)

Email Address:  CSUF:

      

 Personal:

      

(Please check the box next to your PREFERRED email)



CWID:

      



Local Address:

      

Street Address (Line 1) Street Address (Line 2)

      

City State Zip Code Country
Permanent Address:

      

Street Address (Line 1) Street Address (Line 2)

      

City State Zip Code Country



Home Phone:

      

Cell Phone:

      




Disadvantaged:

 Yes  No

If yes, elaborate why you consider yourself disadvantaged:      


Will you apply for a fee waiver from the centralized application service? Yes No
How many hours per week, on average, were you employed during the semester?

 1-10


 10-20

 20-35


 35+
Please indicate your parent’s level of education, ethnicity and race:
Father Education Level:  No College  Some College  College Graduate  Graduate School
Father Ethnicity (for statistical purposes only):

 Hispanic/Chicano(a)/Latino(a) (a person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race)

 Not Hispanic

 Declined to state




Father Race (for statistical purposes only):

 American Indian or Alaska Native – A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.

 Asian – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

 Black/African American – A person having origins in any of the black racial groups in Africa

 Middle Eastern- A person having origins from western Asia and northeast Africa, including the nations on the Arabian Peninsula, Egypt, Iran, Iraq, Israel, Jordan, Lebanon, Syria, and Turkey.

 Native Hawaiian or Other Pacific Islander – A person having origins in any of the original peoples of Hawaii, Guam, Samoa, Polynesia, Micronesia, or other Pacific Islands

 White – A person having origins in any of the original peoples of Europe

 Decline to State
Mother Education Level: No College  Some College  College Graduate  Graduate School

Mother Ethnicity (for statistical purposes only):

 Hispanic/Chicano(a)/Latino(a) (a person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race)

 Not Hispanic

 Declined to state


Mother Race (for statistical purposes only):

 American Indian or Alaska Native – A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.

 Asian – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

 Black/African American – A person having origins in any of the black racial groups in Africa

 Middle Eastern- A person having origins from western Asia and northeast Africa, including the nations on the Arabian Peninsula, Egypt, Iran, Iraq, Israel, Jordan, Lebanon, Syria, and Turkey.

 Native Hawaiian or Other Pacific Islander – A person having origins in any of the original peoples of Hawaii, Guam, Samoa, Polynesia, Micronesia, or other Pacific Islands

 White – A person having origins in any of the original peoples of Europe

 Decline to State




II. INTENT TO APPLY

Please check the types of schools/programs to which you are applying.

 Allopathic Medicine (M.D.)  Optometry (O.D.)  Pharmacy (Pharm.D.)

 Osteopathic Medicine (D.O.)  Dual degree program (M.D./Ph.D.)  Podiatric Medicine (D.P.M.)

 Dental (D.D.S or D.M.D.)  Physician Assistant (P.A.)  Veterinary Medicine (D.V.M.)



 

Please state the purpose of your Intent to Apply Application. Please only check 1 box.

 Establishing a file to collect letters of evaluation and do not intend to apply for the 2017-2018 application cycle.

 Applying for a letter packet. Please note that a letter packet does not contain a committee letter but rather is a compilation of all letters of evaluation requested.

 Applying for a committee packet. A committee packet contains a committee letter and all other letters requested.

III. LETTERS OF EVALUATION
A minimum of 1 letter of evaluation from a health professional must be submitted by February 27, 2017 in order to complete your intent to apply application. All your letters of evaluation, with the exception of the one, do not need to be received by February 27th deadline. Typically students should include at least one letter from a healthcare professional and at least one from a science faculty in their committee packet. Students should refer to the professional program to which you will be applying, to learn more about their specific letter requirements. The committee prefers letter writers to submit both a .docx and a .pdf. It is recommended that a letter writer update his or her letter of evaluation if over a year old, as many institutions discard a letter older than 365 days. For more information about how to request a letter of evaluation, please visit: http://www.fullerton.edu/health_professions/applicationprocess/intent/LOR.asp
RECOMMENDER 1

Full Name:

     

Job Title:

     

Dept/Inst:

          

Date Requested:

     

Contact Info (email):

     

Clinical Letter?

 Yes  No

RECOMMENDER 2



Full Name:

     

Job Title:

     

Dept/Inst:

      

Date Requested:

     

Contact Info (email):

     

Clinical Letter?

 Yes  No

RECOMMENDER 3



Full Name:

     

Job Title:

     

Dept/Inst:

     

Date Requested:

     

Contact Info (email):

     

Clinical Letter?

 Yes  No

RECOMMENDER 4



Full Name:

     

Job Title:

     

Dept/Inst:

     

Date Requested:

     

Contact Info (email):

     

Clinical Letter?

 Yes  No

RECOMMENDER 5



Full Name:

     

Job Title:

     

Dept/Inst:

     

Date Requested:

     

Contact Info (email):

     

Clinical Letter?

 Yes  No

RECOMMENDER 6



Full Name:

     

Job Title:

     

Dept/Inst:

     

Date Requested:

     

Contact Info (email):

     

Clinical Letter?

 Yes  No

RECOMMENDER 7



Full Name:

     

Job Title:

     

Dept/Inst:

     

Date Requested:

     

Contact Info (email):

     

Clinical Letter?

 Yes  No

RECOMMENDER 8



Full Name:

     

Job Title:

     

Dept/Inst:

     

Date Requested:

     

Contact Info (email):

     

Clinical Letter?

 Yes  No


IV. ACADEMIC BACKGROUND


Remember that you must submit an unofficial transcript for every undergraduate or graduate institution where you completed college coursework (if applying for a committee letter). If the information is posted on another transcript you submit, there is no need to forward the transcript to use if it is posted on another document that you submit to us. Please note, the Health Professions office does not forward official transcripts to the professional program/school one applies to. Transcripts need to come directly from the registrars’ office.



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