List the medical, osteopathic, or other applied health schools to which you intend to apply.
Most applicants apply to at least twelve or thirteen schools, including several from their state of
residence. (We understand that this is a tentative list)
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Have you had any actions taken against you for misconduct either while at Wooster or in any
other location? If yes, please specify what happened. Use additional sheet if necessary.
Do you intend to apply to any school on an early decision basis? Yes No
I agree that the committee letter of support written on my behalf by the Pre-Health
Advising Committee will remain confidential. I hereby voluntarily and irrevocably waive
all rights of access to this statement as conferred by the Family Educational Rights and
Privacy Act of 1974 (P.L. 93-380) as amended, or otherwise.
Signature:______________________________________________ Date: ______________
** Please notify us at prehealth@wooster.edu if any information on this form changes after it is
submitted**
