APEX Application

Academic Preparation for EXcellence (APEX) Program
APPLICATION

Upon successful completion of the APEX Program, all APEX Program students will be considered for medical school interview at MSM upon receipt of their completed AMCAS and MSM applications. An applicant's performance in the APEX Program will receive serious consideration by the MSM Admissions Committee when that applicant's file is under review.

NOTE: Any information you submit on this application will not be sold or passed along to a third party (see Morehouse School of Medicine's Privacy Statement).

NOTE: All questions marked with an * are required to consider the application complete. Once you have entered data into the fields, your information will automatically be saved.

APPLICANT INFORMATION

* Last Name

* First Name

Middle Initial

* Date of Birth

* Social Security Number

* Citizenship

AAMC ID Number

* PREFERRED MAILING ADDRESS (Street and Apartment #)

* City

* State

* Zip Code

Country

* Home Number

Cellular Telephone

Email Address

LEGAL PERMANENT ADDRESS (if different from above)

City

State

Zip Code

Country

PARENT/GUARDIAN

* Full Name

Relationship to applicant:

Parent

Guardian

Other

* Telephone Number

* Mailing Address

* City

* State

* Zip Code

Country

ACADEMIC PROFILE

* In chronological order, list all colleges and universities attended and degrees conferred. Write "N/A" in the Degree field if no degree has been conferred.

	Institution	City/State	Major	Degree	Start date (mm/yyyy)	End date (mm/yyyy)
1
2
3
4
5

* PREREQUISITES: Please list all prerequisite courses taken and grades earned. One year of each course is required for consideration for the APEX Program.

	Title	Course Number	Semester Hours	Grade
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

* Overall GPA

* Science GPA

Graduate GPA (if applicable)

Applications will be considered incomplete until all official transcripts from all academic institutions attended have been received. Grades for courses in progress must be received before the start of the program.

If you have not graduated at the time of this application, what is your expected date of graduation?

* Expected graduation date

* MCAT: At least one MCAT score is required at the time of application to the APEX Program. Please list the scores and dates of your most recent MCAT examinations.

	VR	PS	BS	WS	Date (mm/dd/yyyy)
Scores 1
Scores 2
Scores 3

If you have not graduated at the time of this application, what is your expected date of graduation?

COMMUNITY SERVICE & HEALTH-RELATED ACTIVITIES

* Please list extracurricular activities in which you have been involved, particularly those devoted to community service, shadowing experiences and any other health-related activities.

	Activity	Position Held	Begin date (mm/yyyy)	End date (mm/yyyy)
1
2
3
4
5

HONORS & ACADEMIC AWARDS

Please list any honors or academic awards you have received.

	Honor/Award	Organization	Date (mm/yyyy)
1
2
3
4
5

SUPPLEMENTAL INFORMATION

* PERSONAL STATEMENT: Please describe your interest in medicine and community service and why you want to attend the Morehouse School of Medicine APEX Program (500 words max).

0/500 words

* LETTERS OF REFERENCES - PREVIOUS APPLICANT: I am a previous applicant to Morehouse School of Medicine and would like to use the letters of reference submitted for me in the 2011/2012 admissions cycle.

* LETTERS OF REFERENCE: A minimum of three letters of reference are required with at least two submitted by science faculty. Please list each of the references contact information below.

Reference letters should be mailed to Morehouse School of Medicine, APEX Program, Office of Admissions and Student Affairs, 720 Westview Drive, SW, Atlanta, GA 30310.

	Name	Institution/Other	Address
1.
2.
3.

* In accordance with the Family Education Rights & Privacy Act, as amended, all information regarding decisions on your application is considered confidential. You have the option to elect to have your premedical advisor informed of action taken on your application by the Committee on Admissions.

I wish to have my premedical advisor informed of action taken on my application by the Committee

I do not wish to have my premedical advisor informed of action taken on my application by the Committee.

Not Applicable

* PERSONAL INFORMATION (answer all questions and elaborate below if necessary):

Have you ever discontinued or been dismissed from any school or college for reasons of scholarship, discipline or health?
Have you ever been convicted of a criminal offense or are there criminal charges pending against you?

If the answer to any part of the question above is yes, please give specific details below:

PHOTO RELEASE FORM: In the event that photos are taken of the applicant while their enrolled in any of the APEX Program, we ask that you download, read and sign the Morehouse School of Medicine photo release form.

I understand that the Committee on Admissions will not consider this application until all supporting documentation has been received, and it is my responsibility to see that these are received by the stated deadline.

I certify that the information provided in this application is complete and correct to the best of my knowledge and belief, and I accept the requirements as stated in the Application and Admissions information guide.

I acknowledge the right of Morehouse School of Medicine to exclude at any time an applicant whose academic standing or general conduct is considered unsatisfactory.

I acknowledge that participation in the MSM APEX Program does not constitute admission to the regular M.D. Program.

* Signature (write full name)

* Today's Date

Print Completed Application Now

Thank you for completing the online application for the Morehouse School of Medicine APEX Program.

PLEASE PRINT YOUR APPLICATION BEFORE CLICKING THE SUBMIT BUTTON BELOW.

Please print this application and mail it along with a $35.00 application fee (money order or cashier's check only - no personal checks - paid to the order of Morehouse School of Medicine APEX Program). Applications must be postmarked by February 15, 2012.

The completed application and fee, official transcripts, letters of reference, photo release form and personal statement should be mailed to:

Morehouse School of Medicine
Office of Admissions and Student Affairs
APEX Program
720 Westview Drive SW
Atlanta, GA 30310-1495

* Indicates Response Required