HPAC Dossier 2024 Cycle

URI PRE-HEALTH ADVISING

Health Professions Advisory Committee Applicant Dossier
1. IDENTIFYING AND CONTACT INFORMATION
Name (first, middle initial, last):*
URI ID#*
Please upload a .jpg photo of yourself, passport style and professional in nature.

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Select the type of program to which you are applying:*
If other, please indicate:
What year do you hope to begin your professional training?*
Email Address:*
example@example.com
Mobile Phone Number:*
Permanent Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Country

2. BIOGRAPHIC & DEMOGRAPHIC INFORMATION
Date of Birth (MM/DD/YYYY):*

MonthDayYear
Date
City in which you were born
State or Country
Citizenship
If other, please indicate
Self-Identification--Racial
Self-Identification—Ethnic
Do you consider yourself to be a first-generation college student?
Do you consider yourself to be from an economically and/or educationally disadvantaged background?

What languages do you speak? (Optional)*

	LANGUAGE	PROFICIENCY	FREQUENCY OF USE IN YOUR CHILDHOOD HOME
Language 1
Language 2
Language 3

In what city did you spend the majority of your life from birth to age 18? (Optional):
How would you describe this area?

Parents and/or guardians:

	NAME	RESIDENCE (CITY, STATE/COUNTRY)
Parent 1
Parent 2

Parents and/or guardians' information

	OCCUPATION	HIGHEST DEGREE EARNED	LIVING?
Parent 1
Parent 2

Your siblings

	NUMBER	AGES(S)
Sister(s)
Brother(s)

3. ACADEMIC INFORMATION

List your major/degree program(s) at URI:*

	MAJOR	DEGREE TYPE	GRADUATION DATE (MM/YYYY)
Major 1
Major 2
Major 3

List any minors you plan to complete (if applicable)

If you attended other two or four-year colleges, please list them below

	SCHOOL(S)	DATES ATTENDED	NUMBER OF CREDITS EARNED

If you are in a graduate program now, or have completed a graduate program, please list the school name, program, and degree
More information about your graduate program

DATES ATTENDED DEGREE COMPLETED?
Secondary Education

Please list the secondary/high school from which you graduated
SCHOOL
GRADUATION YEAR
CITY
STATE
Undergraduate Grades
From the GPA calculator, please fill in the following boxes:
Cumulative GPA:*
BCPM GPA:*
Upload transcripts & GPA calculator:
- Below please upload any transcripts you have from colleges or universities OTHER THAN URI. You can upload up to three transcripts
- Please also upload your GPA calculator
Upload transcript #1 (non-URI)

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Upload transcript #2 (non-URI)

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Upload transcript #3 (non-URI)

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Upload GPA calculator

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4. WORK AND ACTIVITIES

See pages 2-3 of the Supplemental Instructions
Upload your resume

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Experience 1, Most Meaningful
Experience name:
Experience type:
Experience start/end dates:
Organization name:
Location (city/town, state, country):
Supervisor or Contact Person:
Total Hours:
Description (limited to 700 characters with spaces):

0/700
How was this experience most meaningful for you? (limited to 1,325 characters with spaces):

0/1325
Experience 2, Most Meaningful
Experience Name:
Experience type:
Experience start/end dates:
Organization Name:
Location (City/Town, State, Country):
Supervisor or Contact Person:
Total Hours:
Description (limited to 700 characters with spaces):

0/700
How was this experience most meaningful for you? (limited to 1,325 characters with spaces):

0/700
Experience 3, Most Meaningful
Experience Name:
Experience type:
Experience start/end date:
Organization Name:
Location (City/Town, State, Country):
Supervisor or Contact Person:
Total Hours:
Description (limited to 700 characters with spaces):

0/700
How was this experience most meaningful for you? (limited to 1,325 characters with spaces):

0/700
Experience 4
Experience Name:
Experience Type:
Experience Start/End Dates:
Organization Name:
Location (City/Town, State, Country):
Supervisor or Contact Person:
Total Hours:
Description (limited to 700 characters with spaces):

0/700
Experience 5
Experience Name:
Experience Type:
Experience Start/End Date:
Organization Name:
Location (City/Town, State, Country):
Supervisor or Contact Person:
Total Hours:
Description (limited to 700 characters with spaces):

0/700
Experience 6
Experience Name:
Experience Type:
Experience Start/End Date:
Organization Name:
Location (City/Town, State, Country):
Supervisor or Contact Person:
Total Hours:
Description (limited to 700 characters with spaces):

0/700
Experience 7
Experience Name:
Experience Type:
Experience Start/End Date:
Organization Name:
Location (City/Town, State, Country):
Supervisor or Contact Person:
Total Hours:
Description (limited to 700 characters with spaces):

0/700
Experience 8
Experience Name:
Experience Type:
Experience Start/End Date:
Organization Name:
Location (City/Town, State, Country):
Supervisor or Contact Person:
Total Hours:
Description (limited to 700 characters with spaces):

0/700
Experience 9
Experience Name:
Experience Type:
Experience Start/End Date:
Organization Name:
Location (City/Town, State, Country):
Supervisor or Contact Person:
Total Hours:
Description (limited to 700 characters with spaces):

0/700
Experience 10
Experience Name:
Experience Type:
Experience Start/End Date:
Organization Name:
Location (City/Town, State, Country):
Supervisor or Contact Person:
Total Hours:
Description (limited to 700 characters with spaces):

0/700
Experience 11
Experience Name:
Experience Type:
Experience Start/End Date:
Organization Name:
Location (City/Town, State, Country):
Supervisor or Contact Person:
Total Hours:
Description (limited to 700 characters with spaces):

0/700
Experience 12
Experience Name:
Experience Type:
Experience Start/End Date:
Organization Name:
Location (City/Town, State, Country):
Supervisor or Contact Person:
Total Hours:
Description (limited to 700 characters with spaces):

0/700
Experience 13
Experience Name:
Experience Type:
Experience Start/End Date:
Organization Name:
Location (City/Town, State, Country):
Supervisor or Contact Person:
Total Hours:
Description (limited to 700 characters with spaces):

0/700
Experience 14
Experience Name:
Experience Type:
Experience Start/End Date:
Organization Name:
Location (City/Town, State, Country):
Supervisor or Contact Person:
Total Hours:
Description (limited to 700 characters with spaces):

0/700
Experience 15
Experience Name:
Experience Type:
Experience Start/End Date:
Organization Name:
Location (City/Town, State, Country):
Supervisor or Contact Person:
Total Hours:
Description (limited to 700 characters with spaces):

0/700

SECTION 5. SHORT ESSAYS
Important: Read Supplemental Instructions, Page 4, Before Proceeding

Each short essay is limited to 2,000 characters with spaces.
ESSAY 1
Pick an example of a challenge/difficulty you have encountered that is of a personal, extra-curricular, or academic nature. What Insight have you gained about yourself and others from this event? Which skills, resources, and/or strategies did you rely upon? How will it influence your time in medical/other school and your professional practice?

0/2000

ESSAY 2
How are you sure you want to pursue your chosen career? What have you learned about it from your various experiences that convinces you you are ready to make this commitment? Be sure to back up your claims with examples from your experiences (e.g., academic, work, internships, volunteer, etc.).

0/2000

ESSAY 3
Write a brief biographical sketch of yourself. Consider describing where you grew up, your family, and/or other influences on you.

ESSAY 4
Given that health profession schools are committed to building a diverse learning community, please reflect on your own diverse experiences and how they will allow you to successfully participate in teams and engage in active learning with your peers, faculty, and patients. When composing your response please consider how these experiences influenced your understanding of others and yourself as well as any new insights you gained.

0/2000

SECTION 6. PERSONAL STATEMENT
Important: Read Supplemental Instructions, Page 4, Before Proceeding

Enter your personal statement into the text boxes that follow below. Limited to 5,300 characters with spaces.
0/5300

SECTION 7. STANDARDIZED TEST INFORMATION
Please provide the following information about all exams you have taken or plan to take.

Medical or Podiatry School Applicants—Most Recent MCAT Scores:

	DATE (INTENDED OR COMPLETED)	TOTAL SCORE	CHEMICAL & PHYSICAL FOUNDATIONS	CRITICAL ANALYSIS & REASONING	BIOLOGICAL & BIOCHEMICAL FOUNDATIONS	PSYCH, SOC & BIOL FOUNDATIONS
1st Attempt
2nd Attempt
3rd Attempt

Dental School Applicants—Most Recent DAT Scores:

	DATE (INTENDED OR COMPLETED)	PERCEPTUAL ABILITY	QUANTITATIVE REASONING	READING COMP.	BIOLOGY	GENERAL CHEM	ORGANIC CHEM	TOTAL SCIENCE	ACADEMIC AVERAGE
1st Attempt
2nd Attempt

Optometry School Applicants—Most Recent OAT Scores:

	DATE (INTENDED OR COMPLETED)	QUANTITATIVE REASONING	READING	BIOLOGY	GENERAL CHEM	ORGANIC CHEM	PHYSICS	TOTAL SCIENCE	ACADEMIC AVERAGE
1st Attempt
2nd Attempt

What were your SAT or ACT scores?

Enter scores for the test(s) that apply to you. You may enter up to two sets of scores.

	SAT EVIDENCE BASED READING & WRITING	SAT MATH	SAT TOTAL SCORE	ACT COMPOSITE SCORE
1st Attempt
2nd Attempt

Important: Read Supplemental Instructions, Pages 3-4, Before Proceeding

SECTION 8. LETTERS OF EVALUATION
In the boxes below, please enter:
- Name of letter-writer
- Their title and institution, company, or other entity
- Email address
- Their relationship to you (e.g., course instructor, research mentor, etc.)
Important: Read Supplemental Instructions, Page 4, Before Proceeding
Recommendation 1 (name, title, entity, email, relationship)*
Recommendation 2 (name, title, entity, email, relationship)*
Recommendation 3 (name, title, entity, email, relationship)*
Recommendation 4 (name, title, entity, email, relationship)*
Recommendation 5 (name, title, entity, email, relationship)

SECTION 9. INSTITUTIONAL ACTION
By typing my name below, I acknowledge that I have read the Statement on Institutional Action in the Supplemental Instructions, Page 5 and understand that I must truthfully answer questions asked of me on applications and in this dossier (see below), and represent myself honestly and accurately in the admission process.

Were you ever the recipient of any institutional action from any college or university for unacceptable academic performance or violations of a code of conduct?


Choose one from the dropdown menu

Signature---Type your full name:*
Date (MM/DD/YYYY):*

MonthDayYear
If you have answered yes above, please explain:

SECTION 10. HPAC COMMITTEE LETTER OF EVALUATION WAIVER
Important: Read Supplemental Instructions, Pages 5-6 Before Proceeding
In order for your dossier to be reviewed by the Health Professions Advisory Committee (HPAC), you must select one of the following options regarding your rights to access the HPAC letter of evaluation.
Family Educational Rights and Privacy Act of 1974 as amended or otherwise.

I hereby irrevocably and voluntarily waive all rights of access to the HPAC letter of evaluation conferred by the Family Education Rights and Privacy Act of 1974 as amended or otherwise.I do not wish to waive my rights of access to the HPAC letter of Evaluation
Full Name:*
Date (MM/DD/YYYY):*

MonthDayYear
Deadlines:
See Page 6 of the Supplemental Instructions for your applicable submission deadline.
Should be Empty:

URI PRE-HEALTH ADVISING

Secondary Education

Undergraduate Grades

Experience 1, Most Meaningful

Experience 2, Most Meaningful

Experience 3, Most Meaningful

Experience 4

Experience 5

Experience 6

Experience 7

Experience 8

Experience 9

Experience 10

Experience 11

Experience 12

Experience 13

Experience 14

Experience 15

ESSAY 1

ESSAY 2

ESSAY 3

ESSAY 4

SECTION 6. PERSONAL STATEMENT

Deadlines: