ࡱ> %` Dxbjbj 4z̟̟bHHHH4448l@,'xh~~~ $!&&&&&&&$(h*p&#$#$#$&HH~~4'C&C&C&#$^H8~~&C&#$&C&C&C&~l 34$C&&'0'C&^+?%^+C&^+C&X\"v"TC&&#Dj#\"\"\"&&%^\"\"\"'#$#$#$#$ppHHHHHH  Lowell House Premedical Questionnaire: Part II Dear Lowell House Premedical Applicant, This document is a brief supplement to the Lowell Premedical Questionnaire: Part I, which you completed in April. In it you will provide a list of the medical schools to which you have chosen to apply, as well as the list of recommendations you intend to submit with your application. We invite and encourage you to discuss both of these lists with the Lowell House Premedical Committee before submitting this Questionnaire. Please remember, though, that all of your letters of recommendation are confidential, that you have waived your right to examine their contents, and that we may not advise your selection on the basis of their content. In submitting the Lowell Premedical Questionnaire Part II, please adhere to the following guidelines: (1) Deadline: This form must be received at lohomed@fas.harvard.edu by 4 pm on May 15 in the year you apply. If we do not receive this form and necessary enclosures (see below), we will assume that you have decided not to apply to medical school this year and we will not write a House letter for you this year. (2) Completion: This form is a secured Microsoft Word Template. It can be completed in Microsoft Word, but note that only the relevant fields can be edited. (3) Submission: When you complete the form, please save and e-mail the resulting file to  HYPERLINK "mailto:lohomed@fas.harvard.edu" lohomed@fas.harvard.edu. Please be sure to change the default file name to LowellPremedicalQuestionnaireII-LastFirst, where 'Last' and 'First' indicate your last and first names, respectively. (4) Electronic Enclosures: Along with this form, please attach a PDF draft of your AMCAS application, or as much of it as you have completed. Eventually we hope to help you refine drafts of each section of the application, including your biographical information, transcript inventory, and especially your resume and personal statement. (5) Questions and Advising: Please direct any questions you may have to the Premedical Committee at the above e-mail address. Please also contact the various members of the Premedical Committee for help revising your AMCAS essay, guidance in finalizing your list of schools, and any other questions or concerns throughout the process. (6) Reminders: (a) Please remember that all recommendations to be sent out with your Lowell House letter must also be received in the House Office by 4 pm on May 15 in the year you apply. It is your responsibility to check with the House Office (617-495-2283 or  HYPERLINK "mailto:lowell@fas.harvard.edu" lowell@fas.harvard.edu) to confirm that all of your recommendations have been received. Please be courteous with the office staff and bear in mind that the House Office does not operate full-time during the summer. (b) It is also important for you to send us any new MCAT scores or other relevant information you update after submission of this part of the questionnaire. (c) Please contact us at lohomed@fas.harvard.edu if your permanent address or e-mail address changes during the course of the application process. (Graduating Seniors: We must have your @post e-mail addresses). Good luck! Sincerely, The Lowell House Premedical Committee Last Modified May 2009 by B. I. Rapoport Basic Information Graduation Year:  FORMTEXT       Social Security Number:  FORMTEXT       AAMC ID Number:  FORMTEXT       Contact Information We must be able to reach you during the summer and throughout the application process. Please provide e-mail and telephone contact information in the boxes below and indicate the dates of validity for each address and number. E-mail 1:  FORMTEXT       Telephone 1:  FORMTEXT       Dates 1:  FORMTEXT       E-mail 2:  FORMTEXT       Telephone 2:  FORMTEXT       Dates 2:  FORMTEXT       Letters of Recommendation: Final List The  Recommender field should include a full name. 'Title' refers to the position, institution, and department of your recommender. Please indicate which letters are in your file and which are yet to be received ('Received?'). Finally, indicate which letters you want to be mailed to medical schools with the Lowell House letter ('Send?'). These selected letters will be sent to all medical schools to which you apply. Remember that it is your responsibility to make sure letters have been received; please check with the House Office if you are unsure. Make sure all proper 'Release of Information' and 'Waiver of Access' forms have been signed by you and are in the House Office. Recommender 1:  FORMTEXT       Title:  FORMTEXT       Received?:  FORMTEXT     Send? :  FORMTEXT     Recommender 2:  FORMTEXT       Title:  FORMTEXT       Received?:  FORMTEXT     Send? :  FORMTEXT     Recommender 3:  FORMTEXT       Title:  FORMTEXT       Received?:  FORMTEXT     Send? :  FORMTEXT     Recommender 4:  FORMTEXT       Title:  FORMTEXT       Received?:  FORMTEXT     Send? :  FORMTEXT     Recommender 5:  FORMTEXT       Title:  FORMTEXT       Received?:  FORMTEXT     Send? :  FORMTEXT     Recommender 6:  FORMTEXT       Title:  FORMTEXT       Received?:  FORMTEXT     Send? :  FORMTEXT     Recommender 7:  FORMTEXT       Title:  FORMTEXT       Received?:  FORMTEXT     Send? :  FORMTEXT     Recommender 8:  FORMTEXT       Title:  FORMTEXT       Receiv012[\   I J N W w 8 9 ! " & 1 U { | ĺĺĭĭĭ}'jThRhBOCJOJQJUjhBOCJOJQJUh8JhBO6CJOJQJhbhBOCJOJQJhBOCJOJQJh$X7hBOCJ OJQJh0hBOCJOJQJh0hBO5CJOJQJhBO5CJOJQJjhBOU+23[\ I J ! 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Be sure to include your state and regional schools, and put an asterisk (*) next to those schools. Remember that after we submit your House letter it remains your responsibility to verify that each school has received your application materials. School 1:  FORMTEXT       School 2:  FORMTEXT       School 3:  FORMTEXT       School 4:  FORMTEXT       School 5:  FORMTEXT       School 6:  FORMTEXT       School 7:  FORMTEXT       School 8:  FORMTEXT       School 9:  FORMTEXT       School 10:  FORMTEXT       School 11:  FORMTEXT       School 12:  FORMTEXT       School 13:  FORMTEXT       School 14:  FORMTEXT       School 15:  FORMTEXT       School 16:  FORMTEXT       School 17:  FORMTEXTPVPXP^P`PbPlPnPpPPPS*S,S.SBSDSFSPSRShSjSlSSսկ}k]կEսՍ]կ/jih ?h)CJOJQJU^JaJh_1vCJOJQJ^JaJ#h ?hBO5CJOJQJ^JaJh ?hBO5OJQJ^JaJ hBOhBOCJOJQJ^JaJ hBOh ?CJOJQJ^JaJh ?CJOJQJ^JaJ.jh ?CJOJQJU^JaJmHnHu#jh ?CJOJQJU^JaJ/j,ih ?h ?CJOJQJU^JaJSSSSSSSSSSSSSTTTTTT&T(TLTNTPTdTfThTrTtTսլՐxսլՐ`սլՐHս/jzkh ?h)CJOJQJU^JaJ/jkh ?h)CJOJQJU^JaJ/jjh ?h)CJOJQJU^JaJh ?CJOJQJ^JaJh_1vCJOJQJ^JaJ hBOhBOCJOJQJ^JaJ.jh ?CJOJQJU^JaJmHnHu#jh ?CJOJQJU^JaJ/jjh ?h)CJOJQJU^JaJS8TTTUhUUVPVVV:WWW$hrhhi\iiiFjjjjjjjjjgdBOtTTTTTTTTTTTTTTU U U0U2U4UHUJULUVUXU|U~UUUϑyϑaϑ/jlh ?h)CJOJQJU^JaJ/jflh ?h)CJOJQJU^JaJ.jh ?CJOJQJU^JaJmHnHu/jkh ?h)CJOJQJU^JaJh ?CJOJQJ^JaJ#jh ?CJOJQJU^JaJh_1vCJOJQJ^JaJ hBOhBOCJOJQJ^JaJUUUUUUUUUUUUUVVV0V2V4V>V@VfVhVjV~VVVVVսլՐxսլՐ`սլՐHս/jnh ?h)CJOJQJU^JaJ/j>nh ?h)CJOJQJU^JaJ/jmh ?h)CJOJQJU^JaJh ?CJOJQJ^JaJh_1vCJOJQJ^JaJ hBOhBOCJOJQJ^JaJ.jh ?CJOJQJU^JaJmHnHu#jh ?CJOJQJU^JaJ/jRmh ?h)CJOJQJU^JaJVVVVVVVVVWWWWWW(W*WPWRWTWhWjWlWvWxWWWWWϑyϑaϑ/jph ?h)CJOJQJU^JaJ/joh ?h)CJOJQJU^JaJ.jh ?CJOJQJU^JaJmHnHu/j*oh ?h)CJOJQJU^JaJh ?CJOJQJ^JaJ#jh ?CJOJQJU^JaJh_1vCJOJQJ^JaJ hBOhBOCJOJQJ^JaJWWWWWWWWXhhhhhh:hhRhThVh`hbhhhhhhսլՐvսլՐ^սլՐF/jqh ?h)CJOJQJU^JaJ/jxqh ?h)CJOJQJU^JaJ/jqh ?h)CJOJQJU^JaJUh ?CJOJQJ^JaJh_1vCJOJQJ^JaJ hBOhBOCJOJQJ^JaJ.jh ?CJOJQJU^JaJmHnHu#jh ?CJOJQJU^JaJ/jph ?h)CJOJQJU^JaJT       School 18:  FORMTEXT       School 19:  FORMTEXT       School 20:  FORMTEXT       School 21:  FORMTEXT       School 22:  FORMTEXT       School 23:  FORMTEXT       School 24:  FORMTEXT       School 25:  FORMTEXT       Additional Schools?  FORMTEXT       Notes to the Premedical Committee Please use this space for any additional notes to the Premedical Committee regarding administratihhhhhhhhhhhh$i&i(ii@iJiLiritiviiiiiiiiiiĶĶxĶ`Ķ/jPsh ?h)CJOJQJU^JaJ/jrh ?h)CJOJQJU^JaJ/jdrh ?h)CJOJQJU^JaJh ?CJOJQJ^JaJh_1vCJOJQJ^JaJ hBOhBOCJOJQJ^JaJ.jh ?CJOJQJU^JaJmHnHu#jh ?CJOJQJU^JaJiiiiijjj&j(j*j4j6j\j^j`jtjvjxjjjjjjjjjjjսլՐxսլՐ`սլՐHս/j(uh ?h)CJOJQJU^JaJ/jth ?h)CJOJQJU^JaJ/jkBuDuluxuzu~uuuuuuuuuuu:xx@xBxDx$a$gdBO$a$gd ?gdBO$a$gd ?ve details of your application, including details of contact information or additional recommendations for which the fields above do not allow sufficient space.  FORMTEXT           Lowell House Premedical Questionnaire: Part II  FILLuuuuuuvxxx6x8x:xx@xBxDxҼҸ hBOhyCJOJQJ^JaJh)hqUjh!CJOJQJUaJh!hBOh!CJOJQJaJh!CJOJQJaJh"-eh!CJOJQJaJIN Name First Middle LAST 21h:pBO/ =!"#$% TDd \  S A 3"`2LToK::iow(TD`! 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