1.At the David Geffen School of Medicine at UCLA, students are provided with curriculum and experiences enabling them to become an “Outstanding Physician, AND…,” dedicating themselves to important societal missions. What missions do you want to embrace? What have you done toward your missions?

2.Respond to the following and indicate how these areas of experience have impacted your progress toward your future career goals in relation to becoming an “Outstanding Physician, AND…”.

3.A – Describe your most unique leadership, entrepreneurial, or creative activity.

4.B – Describe your most important volunteer work and why it was meaningful.

5.C – Describe your most scholarly project (thesis, research or field of study in basic or clinical science or in the humanities) and provide the total number of hours, dates and advisor.

6.Describe how the COVID-19 pandemic has impacted your pathway to medical school. Include any academic, personal, financial or professional barriers, as well as other relevant information.

7.Did you experience or are you anticipating time between graduating from college and matriculating into medical school? If you answered “Yes” to question 4, describe the activities in which you participated or are planning to participate. Examples include additional schooling, employment, or caring for a loved one.

8.Do you identify as being part of a group that has been marginalized (examples include, but are not limited to, LGBTQIA, disabilities, federally recognized tribe) in terms of access to education or healthcare? If you answered “Yes” to question 5, describe how this inequity has impacted you or your community and how educational disparity, health disparity and/or marginalization has impacted you and your community.

9.Are you re-applying to DGSOM? If you answered “Yes” to question 9, describe what has changed since you last applied to DGSOM. Please be specific.