Application: Career Changer / ReStart Program

Please complete the form and click "SUBMIT YOUR APPLICATION" at the bottom when finished.

PHPB Application

Name* (* = required field)

Name Suffix:

Other names used:

About You

Area of Study:

If other, please indicate:

UF PHPB admits students from three populations. Which of these best describes you:

* Pre-requisite Sciences refers to Calculus, Chemistry, Biology, and Physics.

Year of Entry:

If you attend UF, please indicate your UF ID#:

Sex:

Date of Birth:*

City of Birth:

State of Birth:

Country of Birth:

Primary Citizenship:

Do you have dual citizenship:

Yes

No

Are you a permanent US resident:

Yes

No

Contact Info

Mailing Address

Street: *

City: *

State: *

Zip: *

Country: *

Permanent Address (if different from Mailing Address)

Street:

City:

State:

Zip:

Country:

Email address: *

Home Phone:

Mobile Phone:

Work Phone:

Family Info

Father

First name: *

Last name: *

Relationship to Applicant (parent, guardian, step-parent, etc.): *

Country of residence: *

County: *

State/Province: *

Highest education level: *

Living? *

Occupation: *

Gender or Sex: *

Highest Education School Name: *

Living in Household (Y/N)?: *

People in Household: *

Mother

First name: *

Last name: *

Relationship to Applicant (parent, guardian, step-parent, etc.):*

Country of residence: *

County: *

State/Province: *

Highest education level: *

Living? *

Occupation: *

Gender or Sex: *

Highest Education School Name: *

Living in Household (Y/N)?: *

People in Household: *

Evaluators

Two evaluations are required

Evaluators will be asked to complete an evaluation form via email. They do not need to write or send a letter of evaluation.

Evaluators may be any non-family member who knows you in an academic or professional capacity.

Evaluator No. 1

Name: *

Street: *

City: *

State: *

Zip: *

Phone: *

Email: *

Evaluator No. 2

Name: *

Street: *

City: *

State: *

Zip: *

Phone: *

Email: *

Educational Background: Universities Attended

Institution No. 01

Institution: *

Major: *

From (date): *

To (date): *

Degree Earned:

Date Earned/will earn:

Institution No. 02

Institution:

Major:

From (date):

To (date):

Degree Earned:

Date Earned/will earn:

Institution No. 03

Institution:

Major:

From (date):

To (date):

Degree Earned:

Date Earned/will earn:

Institution No. 04

Institution:

Major:

From (date):

To (date):

Degree Earned:

Date Earned/will earn:

Educational Background: Standardized Tests

ACT:

GMAT:

GRE:

MCAT:

SAT:

TOEFL:

Other:

Additional Information

Have you ever applied to medical/dental/veterinary medical or other healthcare programs?*

If yes, list where and when:

Have you ever been placed on probations, dismissed, or had an institutional action from any college or university for reasons pertaining to academic integrity?

Yes

No

If yes, list where and when:

Have you ever been adjudicated guilty or convicted of a misdemeanor, felony or other crime?

Yes

No

If yes, please explain:

Professional Work and Volunteer Experiences*

Organization One

Organization:*

Contact Person:

Address:

Dates of Experiences:

Description of Duties:*

Organization Two

Organization:

Contact Person:

Address:

Dates of Experiences:

Description of Duties:

Organization Three

Organization:

Contact Person:

Address:

Dates of Experiences:

Description of Duties:

Organization Four

Organization:

Contact Person:

Address:

Dates of Experiences:

Description of Duties:

Essays

Describe your decision to pursue a career in healthcare. What was your previous career? Explain why you decided to change to healthcare? What factors contributed to your decision? What do you hope to contribute to your profession and others through a career in healthcare? * [Maximum length: 5300 characters.]

What are your strengths, qualities or attributes that will contribute both to your success at UF and in healthcare? * [Maximum length: 3500 characters.]

Why do you want to attend the UF Pre-health Post-Baccalaureate Program (PHPB)? * [Maximum length: 3500 characters.]

Please explain your previous academic difficulty including what has changed since you last took science courses that would indicate your ability to be successful in the Program. [Maximum length: 2500 characters.]

Is there anything else you wish the admission committee to know? [Maximum length: 3500 characters.]

How did you find out about Pre-Health Post-Baccalaureate Program (PHPB)? [Maximum length: 2500 characters.]

I certify that the above information is current, complete and accurate to the best of my knowledge. *

Please submit unofficial copies of all transcripts to phpostbac@clas.ufl.edu.

Official transcripts and the UF Post-Bac Application must be sent directly to:

UF Office of Admission
PO Box 114000
Gainesville, FL 32611