2020-Bio-Form-v1 0 - questions PDF

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Name: John Doe

netID: jxd101230

Advisor: McDougal

5/4/20219/11/2019

BIOGRAPHICAL FORM 2020 THIS FORM MIMICS THE TMDSAS APPLICATION, EY 2020 TMDSAS will probably make some changes for EY 2021

SCHOOLS AND APPLICATION HISTORY Designate Schools and Programs to which you’ll apply. Are you applying to MD/PhD or other dual degree programs? Which ones? None Have you previously submitted a TMDSAS application? [YES/NO] Have you previously received HPE interviews? [YES/NO] Have you previously completed the HPE process and received a committee letter? [YES/NO] indicates information that HPAC does not collect PERSONAL INFORMATION Contact Info Demographic Info Socioeconomic Info Military Service “Describe how your military experience prepared you for a career as a healthcare provider” 1000 char Optional essay. If applicable, record essay here in unformatted plain text.

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Family Designate any relatives in dentistry, or parents who are physicians or in medical school: No parents are physicians or are in medical school. Significant Person Did someone other than your biological parent(s) play a role in your life? Grandparents raised me for 2 years, when I was in junior high, because my parents worked long hours. Financial Info What % of your college was funded by family: What % of your college was funded by spouse: What % of your college was funded by academic scholarships: What % of your college was funded by financial need-based scholarships: What % of your college was funded by loans: What % of your college was funded by employment or other sources:

0 0 0 50 50 0

Felonies and Misdemeanors Disclose and explain any felonies or misdemeanors that may appear on your record. Do not include minor traffic violations. Health Professions Evaluation Biographical Form - Version 1.0 (5/4/2021) – Page 1 of 10

Public Intoxication, 3/17/2018. I was arrested for public intoxication while walking home from a fraternity party. No charges filed. The incident prompted me to check my priorities and focus on school. I stopped attending parties.

YOUR EDUCATION HISTORY High School ; SAT or ACT Results Colleges Attended List any colleges that granted you credit (or will grant credit by October 2020) Include community colleges that awarded you dual-credit during high school. For each, indicate what degree you are seeking and what year you graduated (or plan to graduate). List each degree earned on a separate line. Collin College ; dual-credit courses only, no degree UT Austin ; BS Accounting, spring 2012 UT Dallas ; BS Biology, spring 2020 UT Dallas ; MS Healthcare Management, spring 2021

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Fresh Start Have you ever enrolled in any undergraduate institution in Texas under the Academic Fresh Start Provision? [YES/NO] Designate Primary Undergraduate Institution: The University of Texas at Dallas Designate Primary Graduate Institution (if any): None Release Information to Advisors? HPE and Clearinghouse participants, indicate YES to allow packet upload Transcripts This section prompts you to request an official transcript from each school listed under “Colleges Attended.” Transcripts should be sent directly from schools to TMDSAS. Transcripts MUST include your TMDSAS ID number (if submitted electronically) or a TMDSAS Transcript Matching Form (if submitted by mail). College Coursework In this section of TMDSAS, enter each college course you’ve taken and grade you earned. The HPE process instead asks you to enter this information on the CHRONOLOGY, below. Planned Enrollment In this section of TMDSAS, enter each college course you plan to take between the time you submit the application and summer 2021.

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EDUCATION AND TRAINING HISTORY Are You a Non-Traditional Applicant? [YES/NO] “Describe the factors that have defined you as a non-traditional candidate and how they impact your application.” 1000 characters Optional essay. If applicable, record essay here in unformatted plain text. Has your education or vocation been interrupted? Describe why, and for which semesters. I did not take classes in fall 2019 because I was recovering from a car accident. After I recovered, starting October, I used that semester to volunteer at a hospice and pre-read textbooks for spring 2020. List Disciplinary Actions from Your School Health Professions Evaluation Biographical Form - Version 1.0 (5/4/2021) – Page 2 of 10

Describe any charges of institutional conduct violation, even if you were acquitted or the charge was dismissed. Describe what occurred, the consequences, and what you learned from the incident. 300 characters/entry. From TMDSAS: Failure to disclose this information is grounds for rejection of your application, withdrawal of any offer of acceptance, dismissal after enrollment or rescission of any degrees granted.

Collusion, 4/10/2017. I worked with a friend to complete a Physics I lab report and we were both charged. We received 0 grades for the assignment. I learned to pay close attention to when collaboration is and is not allowed, and have not repeated that mistake since. PERSONAL BIOGRAPHY Account for all semesters from high school to May 30, 2020 Activities should appear in ONLY 1 section, except paid work List cumulative hours should be through May 30, 2020 Complete sentences are NOT required. Abbreviations are allowed. Academic Recognition List academic honors, awards and other recognitions received since beginning college to the present (veterinary applicants should list activities since beginning high school to the present). Indicate the Award Title, date received, city, country, state and a brief description of the award. 300 characters/entry. 3rd Place State, Academic Decathlon. 5/1/2017; Odessa, TX, USA. After 1 year weekly preparation meetings, extensive self-study, worked with teammates in a buzzer competition to answer academic questions across many fields. Built academic discipline, public speaking, and tolerance of pressure. Non-Academic Recognition List non-academic honors, awards and other recognitions received since beginning college to the present. Indicate the Award Title, date received, city, country, state and a brief description of the award. 300 characters/entry. Employee of the Month, Whataburger, 6/1/2016; Austin, TX, USA. Awarded by manager in recognition of work ethic, customer service skills, and reliability. Leadership List any leadership roles or positions of responsibility held since beginning college to the present. Examples may include leadership roles in clubs/organizations, supervisory roles, etc. Indicate the Role Title, start date, end date, city, country, state and a brief description of the position. 300 characters/entry. Social Chair, fraternity, 8/1/2016-5/15/2017. 6 hrs/mo, 40 hrs; Richardson, TX, USA. Elected by peers based on established relationships and reputation for dependability. Organized six club events. For each, managed risk management paperwork, room reservations, participant safety. Employment List all jobs (paid work experience) held since graduating from high school to the present, including military service. 300 characters/entry. Though you normally list each activity in one section only, paid healthcare activities may be listed here in addition to the healthcare activities section. Indicate the employer, job title, when the job was held, start date, end date, city, hours worked per week, country, state and a brief description of the job. If you held a job every summer, enter each time period as a separate record. Health Professions Evaluation Biographical Form - Version 1.0 (5/4/2021) – Page 3 of 10

Babysitting, 8/1/2015-12/15/2015. 8 hrs/wk, 144 hrs; Richardson, TX, USA. Responsible for safety and education of a 6 and 8 year old, 2 nights/wk while parents working. ER Scribe 6/1/2018-10/1/2020, 20 hrs/wk, 2500 hrs projected; Plano, TX, USA. Working with several doctors in a busy ER, I catalogue patient histories and doctors’ records. Observed thousands of patient interactions. My favorites are when the doctors catch obscure medical conditions. Research Activities List any significant research activities (paid or volunteer) you have participated in since beginning college to the present. 300 characters/entry. Include any publications (submitted as well as published), abstracts and posters. Indicate the Research Activity Name, start date, end date, city, approximate hours worked per week, total cumulative hours, country, state and a brief description of the research If research culminated in any publications, abstracts, or posters, do NOT list the end product and the research separately. Create one entry that describes both the research itself and whatever was produced as a result. Wan Lab; 1/15/2019-5/15/2019; 10 hrs/wk, 200 hrs; Richardson, TX, USA. Heme assays using MCRON machine, spliced genes, to test viral attack vectors on RNA. Weekly meetings with colleagues at UT Dallas, occasionally including German colleagues. Presented 6/3/19 poster to local colleagues. Submitted 8/3/19 to RNA Quarterly. Healthcare Activities List all direct healthcare related activities, for example: shadowing, scribing, clinical research, serving or working as a patient care tech, a nurse, and any direct observation or participation in patient care in a clinic, hospital, or with a physician, dentist, or veterinarian. Both paid and unpaid healthcare activities can be listed here. If you shadowed multiple doctors at the same location, DO NOT create multiple entries – instead, create ONE entry per location and list each doctor in the description. If each doctor you shadowed had a different specialty, you may make a separate entry per specialty. Indicate the Activity Name, start date, end date, city, hours worked per week, total cumulative hours, country, state and a brief description of the activity. 300 characters/entry. Hospice Volunteer 10/1/2019-1/15/2020; 10 hrs/wk, 100 hrs; Richardson, TX, USA. Assisted at Autumn Leaves hospice. Talked with patients and families, bathed patients, provided basic wound care, observed nurses’ and doctors’ interactions with patients. ER Scribe 6/1/2018-10/1/2020; 20 hrs/wk, 2500 hrs projected; Plano, TX, USA. Assisted Working with several doctors in a busy ER, I catalogue patient histories and doctors’ records. Observed thousands of patient interactions. My favorites are when the doctors catch obscure medical conditions. Community Service List any non-healthcare related community service or volunteer activities you have participated in since beginning college to the present. Indicate the Activity Name, start date, end date, city, approximate hours per week, total cumulative hours, country, state and a brief description of the activity. 300 characters/entry. Events through fraternity, 8/1/2016-6/1/2017, 5 hrs/wk, 40 hrs total; Richardson, TX, USA. Food banks, fundraising for charities, and helping to set up for fun runs and health fairs. Health Professions Evaluation Biographical Form - Version 1.0 (5/4/2021) – Page 4 of 10

Extracurricular and Leisure Activities List any significant extracurricular, leisure activities or hobbies you have participated in since beginning college to the present. Indicate the Type of Activity, start date, end date, city, approximate hours per month, total cumulative hours, country, state and a brief description of the activity. 300 characters/entry. Academic Decathlon Prep; 8/1/2016-6/1/2017; 20 hrs/mo, 160 hrs; Richardson, TX, USA. Team study sessions, individual study, and team competitions. Weekly practices on campus, meets in Dallas and Odessa, TX, and Washington, DC. Hiking with fraternity brothers; 8/1/2016-8/7/2016; 0-40 hrs/mo, 40 hrs; Bandura, TX, USA. Backpacked on challenging trails to enjoy each others’ company and the natural beauty of Texas’s semi-arid region. Learned about others’ challenging pasts and worked together to overcome physical challenges. Billiards; 8/1/2013-8/1/2014; 80 hrs/mo, 900 hrs; Austin, TX, USA. I played billiards heavily and became very good, but unfortunately I let my work and relationships slide. I learned better life priorities. Top Meaningful Activities Here you will talk about which of your previously listed activities were most meaningful and why. You are required to identify the most meaningful activity and may list up to three. 500 characters each. ER Scribe; Working with dozens of doctors across thousands of patient visits helped focus my med priorities. 1) I want each patient and family to feel understood and served, even when the patient is beyond medical help. 2) I prefer minimally-invasive tools and methods when possible, to minimize side effects and the cost burden on patients. I therefore prefer non-urgent over urgent care. 3) I enjoy the challenge of obscure diagnoses and aim to let no obscure condition go undiagnosed or misdiagnosed. Hospice Volunteer; Working with patients during end-of-life care helped me to understand the different ways people confront their mortality. Some were resigned, some hopeful, some angry. Some families were broken as a result, whereas others came together. I was inspired to work with patients in times of intense medical needs, and to provide coaching for positive personal and family outcomes. Social Chair; Serving my fraternity brothers as Social Chair was an honor and challenge. I had to meet with administration, coordinate with other fraternities and sororities, and administrate six events. I enjoyed the role even though I got too heavy into partying as a result, leading to my arrest on St. Patrick’s Day 2017. That wake up call led me to reevaluate my college priorities and change my behavior.

ESSAYS Note: the boxes on TMDSAS accept only UNFORMATTED PLAIN TEXT. Medical Applicant Personal Statement The personal essay asks you to explain your motivation to seek a career in medicine. You are asked to include the value of your experiences that prepare you to be a physician. The essay is limited to 5000 characters, including spaces. Required essay. Record essay in unformatted plain text. Dental Applicant Personal Statement The personal essay asks you to explain your motivation to seek a career in dentistry. You are asked to discuss your philosophy of the dental profession and indicate your goals relevant to the profession. The essay is limited to 5000 characters, including spaces. Health Professions Evaluation Biographical Form - Version 1.0 (5/4/2021) – Page 5 of 10

Required essay. Record essay in unformatted plain text. Personal Characteristics - Required of All Applicants Learning from others is enhanced in educational settings that include individuals from diverse backgrounds and experiences. Please describe your personal characteristics (background, talents, skills, etc.) or experiences that would add to the educational experience of others. The personal characteristics essay is limited to 2500 characters, including spaces. Required essay. Record essay in unformatted plain text. Optional Essay Briefly discuss any unique circumstances or life experiences that are relevant to your application which have not previously been presented. Optional Essay is limited to 2500 characters, including spaces. Optional essay. If applicable, record essay in unformatted plain text. DO/PHD & MD/PhD Program Essays 1. Explain your motivation to seek a MD/PhD or DO/PhD dual degree. Discuss your research interests and career goals as an applicant to a dual degree program. 2. Describe your significant research experiences. Include the name and title of your research mentor as well as your contributions to the project. List any publications that have resulted from your work. Each essay is limited to 5000 characters, including spaces. Optional essay. If applicable, record essay in unformatted plain text. PROOF OF RESIDENCY Are You a Texas Resident? [YES/NO] Are You a US Citizen or Permanent Resident? [YES/NO] Note: applicants may need to submit supporting documents. See http://www.tmdsas.com/medical/residency.html SUPPORTING DOCUMENTS Upload Photo Release MCAT or DAT scores Letters of Evaluation If using HPAC’s HPE or Clearinghouse processes, DO NOT designate individual writers. Instead, have your letters sent to HPAC and designate only a single letter on TMDSAS: Health Professions Packet ; [email protected] Dental applicants still need to record the name of one writer who is dentist. All letters, including the dentist letter required for dental applicants, will be included in the Packet. If you complete the HPE Process, the Packet will also include a committee evaluation. TMDSAS allows you to designate one “extra letter.” HPAC recommends that you NOT do so. CASPer In 2020, TMDSAS applicants will likely utilize the CASPer situational judgment test. A link may or may not appear within TMDSAS. Read more about CASPer at https://takecasper.com/

HPAC collects this info on the Quick Sheet, below

Health Professions Evaluation Biographical Form - Version 1.0 (5/4/2021) – Page 6 of 10

PAYMENT AND SUBMISSION To submit your TMDSAS application requires a nonrefundable $185 payment. SECONDARY APPLICATIONS insert your photo here Links to the secondary applications are available on the TMDSAS website. Secondary applications should be completed as soon as you submit your TMDSAS application. Any questions relating to a A business-like photo with secondary application should be directed to the your face clearly visible is school. Any secondary application required most appropriate for HPE and for professional schools. documents and/or fees should be sent directly to the school and NOT to TMDSAS. The following schools require a secondary application: On TMDSAS you’ll upload UT Southwestern Medical Center in Dallas a .jpg, max 100 kB UT Austin Dell Medical School UT Rio Grande Valley School of Medicine McGovern Medical School Texas A&M University College of Medicine Texas Tech University HSC School of Medicine The University of North Texas HSC – Texas College of Osteopathic Medicine Texas Tech University HSC El Paso Paul L. Foster SOM Texas A&M University College of Dentistry Texas A&M University College of Veterinary Medicine

QUICK SHEET Name: John Doe Advisor: McDougal Have you previously applied to medical or dental school? If yes, when? No U.S. citizen or permanent resident? USA If no, country of citizenship: Texas resident? Yes If no, state of citizenship: Native languages: English Other fluent languages: Esperanto What is your major at UT Dallas? BA Biology Semester of graduation? S’2020 List the institution, year, and name of any completed degrees UT Austin, BS Accounting, 2012

Institution

Credits

BCPM BCPM Overall Science Science GPA Credits GPA Health Professions Evaluati

“BCPM GPA” includes:  BIO, including NSC  CHEM  PHYS  MATH, including STAT

UT Austin

120

3.43

12

3.0

Collin College

43

4.0

30

4.0

UT Dallas

34

3.8

28

3.72

197

3.62

70

Total/Averages:

3.71

Medical College Admission Test (MCAT) Date

Total

Percentile

5/11/19

506

71

5/15/20

510

83

CPBS

Percentile

124 124

CARS

43 43

126 128

Percentile

52 86

BCLS

128 130

Percentile

86 99

PSBB

128 128

Percentile

82 82

Dental Admission Test (DAT) Date

PAT

QRT

RCT

BIO

Gen. Che

Org. Che

Total Sci

AC Avg

Health Professions Evaluation Biographical Form - Version 1.0 (5/4/2021) – Page 8 of 10

LETTERS OF EVALUATION HPE participants must solicit 3 letters of evaluation (max 5), including 2 from science professors. Eva...