APPLICATION
Washington University France for the Pre-Med Program
Name (please print) First______________ Middle________ Last________________ (usually called)_________
Soc. Sec. # ________________ Date of Birth __________________ Place of Birth ______________________
Permanent Address ________________________________________________________________________
Permanent Phone # _________________ US Citizen? _______ Other ___________ Visa _________________
Major 1 _______________________ Advisor __________________________ GPA ___________________
Major 2 _______________________ Advisor __________________________ GPA ___________________
Year in School __________________ Cumulative GPA ___________________
School mailing address _____________________________________________________________________
School phone number _____________________ Email address _____________________________________
Father's Name __________________________ Title (Mr., Dr. etc.) _________________________________
Father's Business phone ___________________
Mother's Name _________________________ Tiltle (Mrs., Dr. etc.) ________________________________
Mother's Business phone __________________
A complete application includes the following: 1) Personal data, 2) Two letters of recommendation, 3) A parental consent form, 4) A statement of purpose, 5) The French family questionnaire, 6) Four passport size photos, 7) A curriculum vitae, 8) A copy of your student ID card, 9) An official transcript. A personal responsibility and general release statement obtained from Prof. Winn will be requested upon acceptance. No application will be considered until all parts have been received.
Statement of Purpose: Please attach a 350 to 500 word essay (in English or French) describing your reasons for wanting to participate in this particular program. In this statement, you should concentrate on your academic motivations and goals, including a discussion of former hospital work experience or research experience. This essay will be shared with your assigned physician in France.
Send to: Prof. Colette H. Winn, Washington University, Campus Box 1077, 1 Brookings Drive, St. Louis, MO, 63130-4899, phone 314-935-5477, fax 314-726-3494. The application deadline is December 15th. If space is available, the enrollment period could be extended. Students are encouraged to send their completed applications as soon as possible. Admissions after December 15th are frequently subject to higher competition for fewer slots.
French Faculty Recommendation Form
Washington University France for the Pre-Med Program
Student (Please check one)
________ I waive my right to view this recommendation.
________ I do not waive my right to view this recommendation.
Signature ___________________________________ Date ___________________
___________________________________ is applying to study in France. Please attach a letter which comments on the candidate's academic and personal attributes with regard to his/her suitability for studying overseas. Please be as specific as possible, commenting on such characteristics as initiative, self-discipline, maturity and adaptability.You may attach additional sheets if necessary.
Signature ______________________________________ Date ____________
Name (typed or printed) ___________________________ Email address ______________________________
Department_____________________________________ Phone number ______________________________
Please return to: Prof. Colette H. Winn, Washington University, Campus Box 1077, 1 Brookings Dr., St. Louis, MO, 63130-4899.
Faculty Recommendation Form
Washington University France for the Pre-Med Program
Student (Please check one)
________ I waive my right to view this recommendation.
________ I do not waive my right to view this recommendation.
Signature ___________________________________ Date ___________________
___________________________________ is applying to study in France. Please attach a letter which comments on the candidate's academic and personal attributes with regard to his/her suitability for studying overseas. Please be as specific as possible, commenting on such characteristics as initiative, self-discipline, maturity and adaptability.You may attach additional sheets if necessary.
Signature ______________________________________ Date ____________
Name (typed or printed) ___________________________ Email address ______________________________
Department_____________________________________ Phone number ______________________________
Please return to: Prof. Colette H. Winn, Washington University, Campus Box 1077, 1 Brookings Dr., St. Louis, MO, 63130-4899.
Parent/Guardian Statement Form
Washington University France for the Pre-Med Program
___________________________________ has my permission to participate in Washington University's overseas program in France. I agree to meet the applicant expenses, including all program costs and fees, on the same terms as if the student were at Washington University. I understand that the activities of my student will supervised by faculty or staff during the study portion of this program, however a significant part of the European experience involves my student traveling alone or with other students which has inherent risks outside of faculty control. I further understand that this is an academic program, and that student behavior or attitude that does not conform to the high standards of Washington University may result in my student's removal from the program with minimal or no reimbursement.
I agree to the above.
Parent Signature __________________________________ Date _________________________
Please print name _________________________________
Please return to: Prof. Colette H. Winn, Washington University, Campus Box 1077, 1 Brookings Dr., St. Louis, MO, 63130-4899.
French Family Questionnaire
Washington University France for the Pre-Med Program
Name (Last, First Middle)________________________________________________ Birthdate _________________
Tell us about your family (father's & mother's occupation, brothers' and sisters' names and ages).
What are your career plans?
What are your hobbies and interests (sports, music, art etc.)?
List the languages you have studied and rate your ability to speak each language. (Language, years studied, proficiency-excellent, good, fair, poor).
Would you mind living with a monoparental family (mother and children)?
Would you be comfortable in a family with young children? What would you prefer?
Do you have allergies? (pets, plants, food, medicines?)
Are you prepared to try new dishes?
Do you have any dietary restrictions? (Kosher, vegetarian etc.)
Do you smoke? ____ Does being in a home where someone smokes bother you?
Please tell us anything you feel we should know about you. The more you tell us, the better equipped we will be to find the right family for you. We will make every attempt to address your requests, but we cannot guarantee any specific accommodations. Remember, all new living environments require adjustments and compromise.