Committee Letter Interview Packet

For a sample of the application, you can download a copy here. You will not be able to leave and come back to the application to complete, so if you would like more time to get al of your responses together, please download a copy and then copy your responses when you are ready to submit.

Section 1 : Personal Information

First Name

Middle Name

Last Name

Sex

Preferred Pronouns

Birthdate

Student ID #:

Stony Brook Email

Personal Email

Best Phone Number to Reach You:

Are You A US Citizen?

Residency/Visa Type

Places of Residence

Delete_ID_
Places of Residence
Enter All Places of Residence Starting with the most the recent Country Street City Region Postal Code

Add Address

Applicant ID (AADSAS, AAMC, AACOM, OPTOMCAS, or VMCAS) if Known

Are you planning to apply for the 2024 cycle (meaning you want to attend your professional school in fall 2024)?

Family Information

Father's Information

First Name

Last Name

Occupation

Country

Street

City

Region

Postal Code

Highest Degree

Living

Deceased

Mother's Information

First Name

Last Name

Occupation

Country

Street

City

Region

Postal Code

Highest Degree

Living

Deceased

Do you have any siblings?

Yes

No

Siblings

Brother(s) (Name and Age)

Sister(s) (Name and Age)

Marital Status

Name of Spouse

Do you have any children?

Yes

No

Names and Ages of Children

Section 2: Academics

Dental Admissions Test

Score

Date

DAT test Sections: Please indicate the standard score you received from each section.

Perceptual Ability

Quantitative Reasoning

Reading Comprehension

Biology

General Chemistry

Organic Chemistry

Total Science

Academic Average

GRE

GRE Total Score

Date

MCAT

MCAT Total Score

Date

MCAT test Sections: Please indicate the standard score you received from each section.

Chemical and Physical Foundations of Biological Systems

Critical Analysis and Reasoning Skills

Biological and Biochemical Foundations

Psychological, Social, and Biological Foundations of Behavior

OAT

OAT Total Score

Date

OAT Test Sections: Please indicate the standard score you received from each section.

Quantitative Reasoning

Reading Comprehension

Biology

General Chemistry

Organic Chemistry

Physics

Total Science

Academic Average

Did you or do you plan to take a review course for the admissions test?

Yes

No

High School Information

High School Name

Date of Graduation

Did you obtain a degree from Stony Brook University?

Yes

No

Start Date

End Date

Degree Date

Which Degrees did you earn at Stony Brook:

Did you take any course work at Stony Brook University?

Yes

No

College Information (List schools OTHER THAN STONY BROOK that you attended in chronological order)

You will need to submit an unofficial transcript for each school attended. You can submit an unofficial transcript below or after you submit via the portal

DeleteCollege/University _ID_
College and Universities Attended
School Name Level of Study Address Address Country Street City Region Postal Code Start Date Start Date End Date End Date Degree Earned (Leave Blank if you did not earn your degree) Degree Date Degree Date Credits Earned

Add Another College/University

Upload Transcript

College/University Academic Honors and Awards (Name of Award, Brief Description of Award, Date Received)

GRADE POINT AVERAGES: (BCPM means Biology, Chemistry, Physics, and Mathematics courses)

Enter all grades on a 4.0 Scale

Letter Grade	4.0 Scale
A+	4.0
A	4.0
A-	3.67
B+	3.33
B	3.0
B-	2.67
C+	2.33
C	2.0
C-	1.67
D+	1.33
D	1.0
E/F	0.00
Q	0.00

** Disclaimer: Your Stony Brook grade point average (GPA) and the GPA that is calculated in the autobiographical packet might differ slightly from the GPAs that are calculated by admissions services (AACOMAS, AADSAS, AMCAS, OPTOMCAS, VMCAS, etc.). These differences can be greater if you have taken courses at multiple schools.

DeleteBiology Course _ID_
Biology Courses
Biology Course (example BIO 201) Grade (4.0 Scale) Credits Grade Point

Add Additional Course

Bio Total Credits

Grade Points

DeleteChemistry Course _ID_
Chemistry Courses
Chemistry Course (example CHE 131) Grade (4.0 Scale) Credits Grade Point

Add Additional Course

Chemistry Total Credits

Grade Points

DeletePhysics Course _ID_
Physics Courses
Physics Course (example PHY 131) Grade (4.0 Scale) Credits Grade Point

Add Additional Course

Physics Total Credits

Grade Points

DeleteMath and Statistics Course _ID_
Math and Statistics Courses
Math Course (example AMS 161) Grade (4.0 Scale) Credits Grade Point

Add Additional Course

Math Total Credits

Grade Points

Overall BCPM

Total Credits

Total Grade Point

Overall GPA

Section 3: Employment

Please list and describe all your employment experiences including high school, preferably in chronological order, along with dates and contact information.

DeleteEmployer _ID_
Employment
Employer Title Start Date Start Date End Date (leave blank if still employed) End Date (leave blank if still employed) Supervisor Name Supervisor Title Supervisor Email Supervisor Phone Description

Add Additional Employer

Section 4: Extracurricular Activities

Please list and describe all your extracurricular experiences including high school, preferably in chronological order, along with dates and contact information.

DeleteExtracurricular _ID_
Extracurricular Activities
Exatracurricular Role (example member or president) Start Date Start Date End Date (leave blank if on going) End Date (leave blank if on going) Description

Add Additional Activity

Section 5: Health-Related Experiences

Please list and describe all your health-related experiences including high school, preferably in chronological order, along with dates and contact information.

DeleteHealth-Related Experience _ID_
Health-Related Experiences
Employer Title Start Date Start Date End Date (leave blank if on going) End Date (leave blank if on going) Hours per week Supervisor Name Supervisor Title Supervisor Email Supervisor Phone Description

Add Additional Experience

Section 6: Research

Please list and describe all your research experiences, including high school, preferably in chronological order, along with dates and contact information.

DeleteResearch _ID_
Research
Title Start Date Start Date End Date (leave blank if on going) End Date (leave blank if on going) Hours per Week Total Number of Hours List (Co-)Authorships, Awards, and Presentations Supervisor Name Supervisor Title Supervisor Email Supervisor Phone Description of Your Work

Add Additional Research

Section 7: More About You

List Significant books you have read, your hobbies, and or travels, briefly explaining how they have interested you.

Books

Hobbies

Travel

What has been the most important factor contributing to your successes?

What has been the most important factor in whatever failures you have experienced?

Are you from a disadvantaged background*?

Yes

No

Have you ever been homeless?

*Defined as having at any point included in TWO OR MORE of the following:

been homeless,
been in the foster care system,
been a Free and Reduced Price Lunch program participant,
have had no parents or legal guardians who completed a bachelor's degree,
received a federal Pell grant,
received support from the Special Supplemental NutritionProgram for Women Infants and Children (WIC),
lived in a HRSA rural area or a Medicare and Medicaid designated low-income and health professional shortage area.

Disciplinary problems, on-campus or off-campus, can be a source of worry for applicants. Nonetheless, admissions committees know that no one is perfect and that we can learn from our mistakes, thereby becoming stronger, better, more compassionate people. Use the space below to mention any infractions, on-campus or off-campus, and how they have changed you. Remember that many schools nowadays conduct background checks. (If you have no infractions on your disciplinary record, please put "NONE.")

Include any pertinent information that does not appear in the rest of your autobiographical packet.

Disciplinary Release:

I give permission for the office of Academic and Transfer Advising Services to contact the Office of University Community Standards and the Office of Academic Integrity at Stony Brook University to conduct a background check on my disciplinary history. I understand that access to my student disciplinary history will allow Pre-Professional Advising to provide me with the necessary guidance and assistance through the graduate school application process.

(Print Full Name)

Student ID #:

Section 8: Personal Statement

Upload your personal statement that you are intending to submit in your application (a good draft is fine)

Section 9: References

Waive my right of access to and review of this recommendation I am requesting:

I waive my right

I do NOT waive my right

Enter up to 5 recommenders below. The recommender's will automatically receive email and instructions on how to submit their recommendation.

Recommender 1

Have you already contacted this recommender and will they be sending a letter by email? If you have not already contact your recommender, an email will automatically generated to your recommender.

Yes

No

Recommender Name 1

Title

Institution and Department

Recommender Email

Phone

Recommender 2

Have you already contacted this recommender and will they be sending a letter by email? If you have not already contact your recommender, an email will automatically generated to your recommender.

Yes

No

Recommender Name 2

Title

Institution and Department

Recommender Email 2

Phone

Recommender 3

Have you already contacted this recommender and will they be sending a letter by email? If you have not already contact your recommender, an email will automatically generated to your recommender.

Yes

No

Recommender Name 3

Title

Institution and Department

Recommender Email 3

Phone

Recommender 4

Have you already contacted this recommender and will they be sending a letter by email? If you have not already contact your recommender, an email will automatically generated to your recommender.

Yes

No

Recommender Name 4

Title

Institution and Department

Recommender Email 4

Phone

Recommender 5

Have you already contacted this recommender and will they be sending a letter by email? If you have not already contact your recommender, an email will automatically generated to your recommender.

Yes

No

Recommender Name 5

Title

Institution and Department

Recommender Email 5

Phone

Title