SECTION 1: Personal InformationName* First Last UCFID Email* List majors List minors Health Profession (check all that apply): Pre-Dental Pre-Medical (D.O.) Pre-Medical (M.D.) Pre-Occupational Therapy Pre-Optometry Pre-Pharmacy Pre-Physical Therapy Pre-Physician Assistant Pre-Podiatry Pre-Public Health Pre-Veterinary SECTION 2: Personal EvaluationWhy are you pursuing a career as a (your chosen health profession) as opposed to other health careers?*What attributes, character traits, and/or abilities do you have that you believe would be an asset to you as a future (your chosen health profession)?*What weaknesses do you have that may be potential barriers to admission into your chosen health professional school/program (e.g., history of poor grades, poor time management skills, etc.)?*What alternate plans have you made for your future should you not be accepted to your chosen health professional school/program?*SECTION 3: Experiences/Co-curricular or Extra-curricular ActivitiesCommunity Service/Volunteer – Medical/ClinicalCommunity Service/Volunteer – Medical/Clinical is defined as involvement in a service activity in a medical/clinical setting without guarantee of reward or compensation. List up to 3 of your most prominent medical/clinical community service/volunteer activities.Service ActivityStart DateEnd DateDescription of Activity What lessons did you learn from your medical/clinical community service/volunteer experiences?Community Service/Volunteer – NON-Medical/ClinicalCommunity Service/Volunteer – NON-Medical/Clinical is defined as involvement in a service activity not in a medical/clinical setting without guarantee of reward or compensation. List up to 3 of your most prominent non-medical/clinical community service/volunteer activities.Service ActivityStart DateEnd DateDescription of Activity What lessons did you learn from your non-medical/clinical community service/volunteer experiences?ShadowingShadowing is defined as the non-participant observation of a health professional as s/he cares for and treats patients and carries out other responsibilities of their profession. It is often recommended that you shadow several health professionals in varied specialties. List up to 3 of your most prominent shadowing experiences.Service ActivityStart DateEnd DateDescription of Activity What lessons did you learn from your shadowing experience(s)?LeadershipLeadership is defined as a position of responsibility for others with a purpose to guide or direct the actions of others. Leadership can be demonstrated in a variety of ways, including at school, employment, church, and community and school organizations such as coaching, tutoring, and mentoring. List up to 3 of your most prominent leadership experiences. Service ActivityStart DateEnd DateDescription of Activity What lessons and/or skills did you learn from your leadership experience(s)?ResearchResearch is defined as involvement in a scholarly or scientific hypothesis investigation that is supervised by an individual with verifiable research credentials. Research experience may be gained in any discipline and performed at any site. List up to 3 of your most prominent research experiences.Service ActivityStart DateEnd DateDescription of Activity What lessons did you learn from your research experience(s)? Can you define the hypothesis and explain the results?Other ExperiencesOther Experiences such as work experience or other co-curricular or extra-curricular experiences. List up to 3 of your most prominent “other” experiences.Service ActivityStart DateEnd DateDescription of Activity What lessons did you learn from these other experiences?SECTION 4: Membership (or Planned Membership) in UCF Student OrganizationsCheck all that apply. Most student organizations also have a Facebook page. Association of Pre-Physician Assistants (APPA) Delta Epsilon Mu Pre-Health Fraternity (DEM) Global Medical Brigades Health Awareness and Prevention Society International Medical Outreach (IMO) Knights of Health Occupations Students of America (Knights of HOSA) Medlife Multicultural Association of Pre-Health Students (MAPS) Phi Delta Epsilon International Medical Fraternity (PhiDE) Pre-Dental Student Association (PDSA) Pre-Med AMSA (American Medical Student Association) Pre-Occupational Therapy Organization (P.O.T.O) Pre-Optometry Association (POA) Pre-Pharmacy Society (PPS) Pre-Professional Medical Society (PPMS) Pre-SOMA (Student Osteopathic Medical Association) Pre-Veterinary Society (PVS) Public Health Student Association (.P.H.S.A.) Undergraduate Physical Therapy Association (UPTA) Other List your other student organizations CAPTCHANameThis field is for validation purposes and should be left unchanged.