Please list all pre-dental or premedical enrichment programs, including post-baccalaureate programs, in which you have participated:
Are you currently applying to any other post-baccalaureate or re-application program(s)? ______Yes ______No
If yes, please list:
How did you hear about the Southern California Regional Post-Baccalaureate Program?
Please answer the following short essay questions, provide as much detail as possible and explain the background/circumstances you come from (feel free to write your answer in the space provided, or attach them to a separate sheet of paper):
Describe the geographic location and community of your home during your childhood, including socioeconomic conditions, housing, rural, urban, foreign country, and other representation. Do you
come from a historically disadvantaged community/neighborhood with limited educational and
supportive resources? (i.e., neighborhoods with a high percentage of high school dropouts, where
few go on to attend college; neighborhoods with high unemployment and associated socioeconomic problems)
Do you come from a region/community where there is a shortage of medical and dental care, or where most of the care is provided by city, county, state, or federal clinics and hospitals? (i.e., rural community, inner-city community) - If yes, please explain.
Describe any specific difficulties in your life. Include how you dealt with them and their influence upon your growth.
How are you financing your education? (attach copy(s) of financial aid award if pertinent)
What was the number of people in your household during your life, from birth to age 18? Did you have any special responsibilities?
Do you provide support to anyone other than yourself? If yes, please explain:
Are you the first (or one of the first) of your family members to attend college, or to apply to professional or graduate school
Have you faced hardships that interfered with your educational pursuits? If so, please describe.
STATEMENT OF INTENT
Please attach a typed 2 – 3 page concise Statement of Intent addressing the following:
Present academic status
Disadvantaged or underserved status
What you expect to gain from participation in the Post-Baccalaureate Program
Please submit three official letters of recommendation. The letters should be from individuals who can attest to your service to the community and your commitment to helping underserved populations. At least one letter should be from a recent teacher or faculty member. Letters submitted for previous AADSAS Dental School applications will be accepted, but the letters author or letter service will need to resend the recommendation to the program directly.
Walk-in application submissions will be accepted from January 29th to April 29th, 5:00pm PST. All mailed application materials must be post-marked by Saturday, April 30th to be processed (included in your application). Materials received after the dates listed above will not be processed. Incomplete applications will not be considered for review.
STATEMENT OF AUTHENTICITY AND PARTICIPATION
I certify that the above information is true and correct. I agree to provide, if requested, any official or unofficial documentation necessary to verify this information. I understand that false statements or misrepresentations on this form may result in cancellation of admission to the Post-Baccalaureate Program.
If accepted to the Post-Baccalaureate Program and I accept, I will participate fully in this Program and abide by all the rules and regulations as stipulated by the Director. This includes my attendance at classes, workshops, special presentations, tutorials and meetings during the stated period of the Program.
It is my full intention to use my knowledge and skills to serve the underserved upon my graduation from dental school.