Wright State University Boonshoft School of Medicine

1.If you earned a medically related certificate/license, how many hours have you worked in that role since earning your certificate/license? If not, please enter N/A.

2.If there has been a significant economic hardship, please explain the circumstances. If none, please enter N/A.

3.If either of your parents are graduates of Wright State University or the Boonshoft School of Medicine, please list their name(s) and graduation year(s). If not, please enter N/A.

4.If you have other relatives that are Wright State University or Boonshoft School of Medicine alumni, current students, faculty or staff, please list their name(s). If not, please enter N/A.

5.If you have applied to Wright State University Boonshoft School of Medicine in a previous cycle, please indicate the year(s) of your previous application(s). If not, please enter N/A.

6.If you are a re-applicant, how has your application changed since the previous cycle? If not, please enter N/A.

7.What is the primary reason that you have chosen to apply to the Wright State University Boonshoft School of Medicine?

8.Are there any specific patient populations that you desire to serve as a physician? If so how do you envision yourself serving those populations?

9.If there has been or will be a gap in your education, please describe how you have/will use this time. If not, please enter N/A.

10.If you consider yourself a non-traditional candidate, please explain. If not, please enter N/A.

11.Briefly describe any extenuating circumstances which you believe are pertinent to your application (i.e., poor grades, withdrawn courses, life events). If none, please enter N/A.

12.If you have attended any allopathic or osteopathic medical school, as a candidate for an M.D. or D.O., please list the name of the school and explain the reason for separation. If not, please enter N/A.

13.If you are not a current resident of the state of Ohio, please describe your connection to Ohio. If not, please enter N/A.

14.If you have a non-familial connection to Wright State University or the Boonshoft School of Medicine, please describe your connection. If none, please enter N/A.