KEEP: CU Pre-Health Scholars Application

CU Pre-Health Scholars Application

Note: Your privacy is very important to us. To better serve you, the form information you enter is recorded in real time.

Thank You For Your Interest in the CU Pre-Health Scholars Program

Please review the following program requirements before proceeding- Priority deadline = April 18th, applications will be accepted on a rolling basis afterwards until the program is full.

We are currently accepting:

10 8th graders

5 9th graders

5 10th graders

Eligibility:

-Must be a current 8th, 9th, or 10th grade student

-Must have and maintain a minimum GPA of 3.0 throughout the duration of the program, and

-Must have a desire to pursue a career in healthcare or a related STEM profession after graduation, and

-Must commit to active participation for the duration of their high school years (3.5 year commitment for freshman applicants, 2.5 year commitment for sophomore applicants) and

-Must be a first-generation college-bound student (neither of whose natural or adoptive parent(s) received a baccalaureate degree in the U.S.) or

-Must be a member of a one-parent family or

-Must be a member of a historically underserved group (i.e. individuals from low-income backgrounds, rural communities, attend schools with limited educational opportunities (AP/extracurriculars), members of racial or ethnic minorities and LGBTQIA communities).

Commitment-

CUPS is committed to providing scholars with every opportunity to develop their academic skills, succeed in high school, and gain entrance into an institution of higher education. However, scholars will gain the benefit from their experiences and fulfill their educational potential only to the extent that they commit themselves to the goals of the Program and actively participate in its activities. Therefore, the Program will expect participants to:

1) Commit themselves to active participation in the Program for the duration of their high school years (4 year commitment for freshman applicants, 3 year commitment for sophomore applicants, 2 year commitment for junior applicants).

2) Attend and involve themselves fully in all program-sponsored activities on the Anschutz Medical Campus:

- Freshmen CUPS scholars will attend monthly Saturday Academy meetings January - May, and a three-week program during the summer.

- Sophomore CUPS scholars will attend monthly Saturday Academy meetings January - May, and a three-week program during the summer.

- Junior CUPS scholars will attend monthly Saturday Academy meetings August - May, and a six-week program during the summer.

- Senior CUPS scholars will attend monthly Saturday Academy meetings August - May (no summer program).

3) Follow a college preparatory curriculum as prescribed by Program staff and high school counselor.

4) Cooperate with the Program staff in all program-related matters.

The CU Pre-Health Scholars Program will begin reviewing applications April 18th 2022 (priority deadline). Final cohort selections will be made by May 1rst, 2022, new participant orientation will be May 14th and the summer program will be in June and July CUPS Website:https://www.cuanschutz.edu/offices/inclusion-and-outreach/programs/cups

Summer program for students in the class of 2023 is from June 13th-July 23rd 2022

Summer program for students in the class of 2024, 2025 July 5th-July 23rd

Summer Program for students in the class of 2026 is from July 11th-July 23rd 2022

Classes go from 9am-3pm (lunch and snacks are provided)

I have read the program requirements.*

I believe I meet the criteria listed above, and I understand the participation requirements.

Please include your email to move on.*

Confirm Please include your email to move on. *

Application Instructions

Please read the following instructions thoroughly before beginning the application.

General - This application requires approximately 1.5 hours to complete. You will be asked to provide general and demographic information, academic information, volunteer experience, work experience, and awards. You may save your work and return to complete the application at a later time if you choose (you will be provided with a unique link that will take you to the application with your progress saved, you will not be able to access your saved work without the link and will have to complete a new application if it is lost).

Please have the following information available before you begin.

Teacher and Counselor Evaluations - You will be asked to provide the names and email addresses for one teacher and your high school counselor so they may submit an evaluation of your academic performance. Both evaluations are required for a complete application. Evaluation requests will be sent to your selected evaluators only after submitting this application. Please check with your teachers and counselor to ensure they have received the invitation to complete an evaluation so your application can be reviewed in a timely manner.

I have read the program application instructions *

I understand all application instructions.

Student & Demographic Information

Name*

First Name

Last Name

Preferred Name*

Date of Birth*

(mm/dd/year)

Current Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Mailing Address (if different than current living address)

Address Line 1

Address Line 2

City

State

ZIP Code

Home Phone*

At Least One Phone Number Is Required (note NA if this does not apply)

Cell Phone*

At Least One Phone Number Is Required (note NA if this does not apply)

Email*

Confirm Email *

Student Email

Are you Hispanic, Chicano, Mexican, Latino, Cuban, Puerto Rican, Central American, or Spanish American?

Yes No

Optional

Race

Optional

Gender ( cis female, cis male, non-binary, genderqueer, trans-women/man)

Sexuallity (queer, gay, lesbian, bi, pan, straight, questioning)

we recognizes the examples above are not all all encompassing, .......

Ability status (learning disability, physical disability, and/or do you struggle with mental health etc...please provide as much detail as you feel comfortable)

Disclosing your disability will enable us to best support you, and will not impact your eligibility in the program

Accomodations

Do you have an IEP? Do you have a 504? If yes, check here to grant us permission to ask your councilor about accessing it? If no, would you like help getting additional support related to your disability? N/A

Parent Information

Total family size (Including yourself, parents or guardians, and other dependents).

Highest Education Attained by Parent or Guardian 1

Highest Education Attained by Parent or Guardian 2

Name of Parent or Guardian 1 *

First Name

Last Name

Name of Parent or Guardian 2*

First Name

Last Name

Parent or Guardian Email Address (main contact)

Confirm Parent or Guardian Email Address (main contact) *

Parent or Guardian Cell Phone (main contact)

At Least One Phone Number Is Required

Parent or Guardian Home Phone (main contact)

At Least One Phone Number Is Required

Are the mailing address and home phone number the same as the student's?

Yes No

Parent or Guardian Address (If Different Than Student's)

Address Line 1

Address Line 2

City

State

ZIP Code

Number of children in college

Number of younger family members in home (siblings, cousins)

Emergency Contact

Please List Someone We Can ALWAYS Get Ahold Of*

Name of Emergency Contact

Relationship to Student*

Emergency Contact

Address of Emergency Contact (If Different From Current Living Address)

Address Line 1

Address Line 2

City

State

ZIP Code

Home Phone

At Least One Phone Number Is Required

Cell Phone

At Least One Phone Number Is Required

Confirm Email *

Emergency Contact

Academic Information

Current High School*

School Information

Student ID Number*

Year in School*

Expected Graduation Year*

Current Cumulative GPA*

Freshman Only- Or Current Term GPA Calculated From Current Grades

Please List Any Science, Healthcare Experience, and All Certifications.*

Are You Currently Taking Part in Any Other Pre-Collegiate Program or Outside Health Related Program*

If Yes, Please List

Community Service/Volunteer Activities

Please Provide Information About Your Volunteer Activities/ Community Service in the Last 2 Years. The Fields Below Are Optional, Please Provide as Many as You Can.

1 Volunteer Activity Name

Volunteer Activity 1

Date(s) of Participation

Volunteer Activity 1

Weekly Time Commitment (In Hours)

Volunteer Activity 1

2 Volunteer Activity Name

Volunteer Activity 2

Date(s) of Participation

Volunteer Activity 2

Weekly Time Commitment (In Hours)

Volunteer Activity 2

Description of Activity

Volunteer Activity 2

3 Volunteer Activity Name

Volunteer Activity 3

Date(s) of Participation

Volunteer Activity 3

Weekly Time Commitment (In Hours)

Volunteer Activity 3

Description of Activity

Volunteer Activity 3

Work Experience

The Fields Below Are Optional, Please Provide as Many as You Can.

1 Name of Current or Previous Employer

Work Experience 1

Weekly Time Commitment (In Hours)

Work Experience 1

Description

Work Experience 1

2 Name of Current or Previous Employer

Work Experience 2

Weekly Time Commitment (In Hours)

Work Experience 2

Description

Work Experience 2

3 Name of Current or Previous Employer

Work Experience 3

Weekly Time Commitment (In Hours)

Work Experience 3

Description

Work Experience 3

Essay Questions

Please answer the following essay questions. For most of the questions there is a recommended 150 word limit, if you would rather record yourself answering the questions, you may do so and upload the files. Please note that one of the questions does require you to submit a creative response (not an essay). If you have trouble uploading the files, you may send them to us. Please email cups@cuanschutz.edu. Include 2022 application in the subject line and introduce yourself.

We are looking for insightful and detailed answers. You will not be assessed based on grammar, spelling or punctuation.

If you would prefer to have an interview instead of writing out your answers to the application questions, please use this link to schedule one; https://cupsinterview.youcanbook.me

The interview questions will be identical to the application questions. If you choose to interview, we expect that you will come prepared.

If you have scheduled an interview, just write n/a in the essay question boxes this will allow you to submit your application.

Would you rather have an interview or submit a written application? If you would prefer an interview use this link (https://cupsinterview.youcanbook.me ) to schedule one and enter the date/time in the box below*

The CUPS program focuses on exploring causes of inequality, and uses of technical innovations in health care, in addition to career exploration. Please describe your career goals and explain why you are interested in this program. Bonus points for connecting your interests and values to the CUPS pillars and values listed on the website.*

For Essay question 1: If you chose to record your answer, please save your file as "your last name_essay 1"upload your file here

No File Chosen