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1. |
Please indicate if you have an interest in any of the following Dual Degree programs:
MD/MPH
MD/MBA
MD w/Thesis
MD/PhD
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2. |
Have you previously participated or are you currently participating in any programs affiliated with NJMS? (To select more than one program, hold down 'Ctrl' key or 'Command' key and select.)
Yes
No
Date(s):
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3. |
Do you have any relatives currently attending or who have graduated from NJMS?
Yes
No
Please provide their name, their relationship to you, and graduation year. |
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4. |
Do you have any other connection to NJMS, UMDNJ, or Rutgers?
Yes
No
Please provide their name, their relationship to you, and institution. |
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5. |
Have you applied to NJMS before, either through AMCAS or an accelerated/combined degree program?
Yes
No
Application Year(s):
Program(s): |
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6. |
Prior to July 1, 2017, have you met with either Dr. Heinrich or Ms. Rivero?
Yes
No
Dr. Heinrich
Ms. Rivero
Approximate Date(s): |
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7. |
We value qualities of integrity, humanism, and passion and are committed to fostering a climate for diversity and inclusion. We feel these factors are critical to your growth as a future physician-leader. How will you contribute to our medical school community? |
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8. |
Please discuss any additional information you believe important for the screening committee to know about you. Feel free to elaborate on any special circumstances, personal examples of resilience, discrepancies in academic history, etc. |
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9. |
Please share any other information you feel uniquely enriches your candidacy for admission to NJMS: |
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10. |
If you don't currently reside in NJ, please share connections (if any) you may have. |
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11. |
If you will not be a full time student between June 2017-August 2018, please describe in detail your planned activities, including chronology and time commitment.
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12. |
Are you the first in your immediate family who will/has graduate(d) from a four year college?
Yes
No
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13. |
Are you the first in your immediate family who will attend medical school?
Yes
No
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14. |
How do you self-identify:
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15. |
I agree that New Jersey Medical School may request and I hereby authorize all appropriate sources, such as educational institutions and employers, to release transcripts and any other information to the Admissions Office for purposes of confirming or supplementing information contained in my application or relating to the admissions process. |
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16. |
I understand that, as a condition of admission, I may be required to authorize NJMS to obtain a supplemental criminal background check. I may also be required to obtain a background check myself or authorize clinical training facilities to conduct this check, and to permit the results to be provided by the reporting agency to NJMS and/or to clinical facilities. |
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17. |
I understand that as per New Jersey Medical School policy, every accepted student will be required to complete the Student Health Immunization requirements and submit the necessary forms as instructed prior to matriculation. I also understand that I will be unable to use my student health insurance to cover the cost of these requirements because satisfaction of these requirements is due in advance of student health insurance activation. |
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18. |
I certify that the information submitted on this application is complete and accurate. I understand that failure to provide complete and accurate information may affect my admission. I also understand that my application will not be considered until the Office of Admissions receives all the necessary documents. |