Instructions: Block
and copy this document into a word processing program. TYPE in the
required information. Be certain to select do or do not at both
places in the signature box, deleting the ones you do not choose. Print
the document, sign and date it. Bring the signed copy to the Biology Office
JSC 111 or mail it to Dr. Tim Knight Chair, HPAC, OBU Box 3792, Arkadelphia, AR
71998-0001. No recommendations will be written until the signed permission
form has been received. In addition, compose the personal statement
for your application (AMCAS, ACCOMAS, AADSAS, etc.) and include it with
your Personal Information Sheet. Send electronic copies to knightt@obu.edu.
Delete these instructions from your submitted copy.
OUACHITA BAPTIST UNIVERSITY
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.
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I (do, do not) 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, do not) 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 AMCAS application.
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