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Application for Six-Year B.A./M.D. Program

MD Application08.indd 1 7/17/08 10:15:43 AM

Instructions for Admission to Baccalaureate M.D. Program

Application checklistDetach and keep for your records

____ * UMKC Application for Admission Complete the enclosed paper application (pages 3-6) or to expedite the process, apply online at www.umkc.edu/admissions. Only one version of the application is needed. U.S. citizenship or permanent resident status by Nov. 1, 2008 is required of all applicants. If you are a permanent resident, a copy of the permanent resident card must accompany your application.

____ * $35 nonrefundable application fee for Missouri residents

____ * $50 nonrefundable application fee for non-Missouri residents

____ * School of Medicine Supplemental Application with essay and short answers (Pages 7-8)

____ *High School Activity Sheet (Page 9)

*School of Medicine Technical Standards (Page 13)

____ * Official high school transcript with your class rank at the end of your junior year Meeting high school core is mandatory. Course requirements: four units of English, four units of math, three units of science, three units of social studies, one unit of fine arts and two units of a single foreign language. (one unit = one year in class)

____ American College Test (ACT) scores and the ACT Student Profile (directly from testing agency) Out-of-state residents may submit SAT results; however the ACT is preferred. You are responsible for sending updated test scores to UMKC throughout the year.

____ Three School of Medicine Reference forms (Pages 15-20) (These are submitted by teachers, counselors or school administrators directly).

Mail your application, test results and all transcripts to: Office of Admissions University of Missouri-Kansas City 120 Administrative Center 5100 Rockhill Road Kansas City, MO 64110-2499

An application cannot be reviewed for admission until all items listed have been received in the Office of Admissions. When all materials have been received in Admissions, they will be reviewed by the Council on Selection at the School of Medicine.

Deadline for submission of application materials is Nov. 1, 2008.

After the review of all applications by the School of Medicine’s Council on Selection, applicants who appear to be well qualified will be invited to the University for an interview. If invited, you will be required to be present at the scheduled date and time of the interview. After all invited applicants have been interviewed, the Council on Selection will offer admission to those candidates who best qualify for the UMKC program. Applicants will be notified in writing of the decision.

* To expedite the review of your application, complete the UMKC Application for Admission (click on the Freshman tab and select “MED-UNDEC-Medicine MD-6yr program”) and Supplemental Application online. Mail the test results, transcripts and remaining items together to the Office of Admissions address. Detach this page and keep for your records. Detach reference forms and distribute to teachers and counselors.

Apply online: www.umkc.edu/admissions


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A&S College of Arts and SciencesBIO School of Biological SciencesBPA Henry W. Bloch School of Business and

Public AdministrationCON Conservatory of MusicDEN School of DentistryEDU School of EducationGRAD School of Graduate StudiesLAW School of LawMED School of MedicineNUR School of NursingPHA School of PharmacySCE School of Computing and Engineering

Undergraduate Degree ProgramsAccounting (BPA) B.S. 026010American Studies (Interdepartmental) (A&S) B.A. 051000Architectural Studies (A&S) # 213500Art (A&S) B.A. 064000Art History (A&S) B.A. 083000Biology (BIO) B.A., B.S. 104000 *Bioinformatics 104007 * Cellular and Molecular Basis

of Health and Disease 104005 **Pre-dentistry 603500Business Administration (BPA) B.B.A. 107010 *Accounting *Enterprise *Entrepreneurship *Finance 107025 *Management *Marketing Chemistry (A&S) B.A., B.S. 124000Communication Studies (A&S) B.A. 139500 *Mass Communication 139545 *Speech Communication 139560Computer Science (SCE) B.A., B.S. 143500 *Bioinformatics 143520Criminal Justice and Criminology (A&S) B.A. 150000Dance (CON) B.F.A. 164000Dental Hygiene (DEN) B.S.D.H. 167000 Clinical and Classroom Teaching Clinical Practice (Fall semester admission only. Deadline is Feb. 1.)Economics (A&S) B.A. 185000Education (EDU) B.A. 200000(Special application packet required for all education majors.)

Early Childhood Education B.A. 188000 Elementary B.A. 200000 Middle School B.A. 375000 Secondary Education B.A. 762000 *Art 762006 *English 762020 *Foreign Languages 762030 French, German, Spanish *Mathematics 762040 *Music 762045 *Natural Science 762050 Biology, Chemistry, Earth Science, Physics *Social Science 762055Engineering (SCE) Civil Engineering B.S.Ci.E. 131500 Electrical Computing Engineering B.S.E.E. 198000 Mechanical Engineering B.S.M.E. 386500English (A&S) B.A. 211000 *Creative Writing B.A. 211040 *Secondary English EducationEnvironmental Studies (A&S) B.A., B.S. 214500French (A&S) B.A. 243000Geography (A&S) B.A., B.S. 269000General Studies, undecided 265000Geology (A&S) B.A., B.S. 271000German (A&S) B.A. 274000History (A&S) B.A. 306000Information Technology (SCE) B.I.T. 332000Liberal Arts (A&S) B.L.A. 368700Mathematics and Statistics (A&S) B.A., B.S. 385000 **Applied Math and StatisticsMedical Technology (BIO) B.S. 389000Medicine 6-Yr. Program (MED) B.S./M.D. 393000 (Fall semester admission only. Application deadline is

Nov. 15. Special application packet required.)Music (CON) B.A. 407000 (UMKC application required along with supplemental

application and audition for all music degrees.) *Music Therapy 407010Music Composition (CON) B.M. 414000Music Education (CON) B.M.E. 415000 *Choral 415010 *Instrumental 415030 *Music Therapy 415040Music Performance (CON) B.M. *Bassoon 481010 *Cello 481015 *Clarinet 481020 *Euphonium 481022 *Flute 481025 *Guitar 481030 *Horn 481040 *Jazz and Studio Music 481043 *Oboe 481045 *Organ 481050

*Percussion 481055 *Piano 481060 *Piano Pedagogy 481061 *Saxophone 481063 *String Bass 481065 *Trombone 481070 *Trumpet 481075 *Tuba 481080 *Viola 481085 *Violin 481090 *Voice 481095 Music Theory (CON) B.M. 419000 Nursing (NUR) R.N.-B.S.N. 438000 Nursing (NUR) B.S.N. 904700 Pharmaceutical Sciences B.S. 487500

Pharmacy (PHA) Pharm.D. 490000(Fall semester admission only. Application deadline is Dec. 15. Provisional admission for high school students: Fall admission only. Deadline is Jan. 15. UMKC application and supplemental application materials required.)Philosophy (A&S) B.A. 492000Physics (A&S) B.A., B.S. 500000Political Science (A&S) B.A. 509000Psychology (A&S) B.A. 706000Sociology (A&S) B.A. 774000Spanish (A&S) B.A. 778000Studio Art (A&S) B.A. 789000 *Graphic Design/Photography 789010Theatre (A&S) B.A. 803000Urban Affairs (A&S) (Interdepartment) B.A. 816000Urban Planning and Design B.A. 826000

Graduate Degree ProgramsCollege of Arts and SciencesArt History (A&S) M.A. 083000Chemistry (A&S) M.S. 124000(Fall semester application deadline is April 15. Spring semester deadline is Oct. 15.) *Analytical Chemistry 124010 *Inorganic Chemistry 124030 *Organic Chemistry 124060 *Physical Chemistry 124070 *Polymer Chemistry 124080Criminal Justice and Criminology (A&S)M.S. 150000 (Summer/Fall semester application deadline is April 1. Spring semester deadline is Nov. 1)Economics (A&S) M.A. 185000 *Applied Economics 185005English (A&S) M.A. 211000 (Fall semester admission only. Application deadline is Feb. 15.) *Creative Writing 211040Geosciences (A&S) Environmental & Urban Geosciences M.S. 213200 Waste Management Certificate 848500History (A&S) M.A. 306000 (Fall semester application deadline is April 30. Spring semester deadline is Oct. 1.)Liberal Studies (A&S) M.A. 370000Mathematics and Statistics (A&S) M.A., M.S. 385000 (Fall semester admission only. Application deadline is March 15.)Physics (A&S) M.S. 500000Political Science (A&S) M.A. 509000Psychology (A&S) Ph.D. 706000(Fall semester admission only. Application deadline for Ph.D. programs is Jan. 15.)

Degree ProgramsSome programs and degrees require special application for admission and have specific entry requirements.To find out more go to www.umkc.edu/admissions.

# The Architectural Studies sequence is a cooperative program with Kansas State University. Students enroll at UMKC in preparation for admission to KSU, where they may be awarded degrees in architecture, landscape architecture and interior architecture.

* Emphasis areas within degree programs that appear on transcripts, but not on diplomas.** Concentrations within degree programs that do not appear on diploma or transcript.***Separate admission application required; contact specific academic unit.


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Romance Languages and Literature (A&S) M.A. 745000Social Work (A&S) M.S.W. 773000 Gerontology Certificate 275500Sociology (A&S) M.A. 774000Studio Art (A&S) M.A. 789000 (Fall semester application deadline is March 1. Spring semester deadline is Oct. 1.)Theatre (A&S) M.A. 803000Theatre (A&S) M.F.A. *Acting 804010 *Design 805010 *Technology 805020

School of Biological SciencesBiology (BIO) M.A. 104000Cellular and Molecular Biology (BIO) M.S. 120010 *Biochemistry 120060 *Bioinformatics 120020

Henry W. Bloch School of Business and Public AdministrationAccounting (BPA) M.S. 026000Business Administration (BPA) M.B.A. *Entrepreneurship 107024 *Finance 107025 *International Business 107027 *Leadership and Change in Human Systems 107065 *General Management 107030 *Management of Information Systems 107028 *Marketing 107040 *Operations Management 107055Public Administration (BPA) M.P.A. 707000 *Health Services Administration 707033 *Human Resources Management 707022 *Nonprofit Management 707011 *Organizational Behavior 707050 *Urban Administration 707080

School of Computing and EngineeringComputer Science (SCE) M.S. 143500 *Bioinformatics 143520 *Computer Networking 143027 *Software Engineering 143505 *Telecommunications Networking 143535Engineering (SCE) Civil Engineering M.S. 131500 Electrical Engineering M.S. 197500 Mechanical Engineering M.S. 386500

Conservatory of Music and DanceMusic (CON) M.A. 407000(UMKC application required along with supplemental application and audition for all music degrees. Recom-mended deadline is Feb. 1.) *Music Therapy 407010Music Composition (CON) M.M., D.M.A. 414000Music Conducting (CON) M.M., D.M.A 144000Music Education (CON) M.M.E. 415000 *Choral 415010 *Instrumental 415030Music History and Literature (CON) M.M. 417000Music Performance (CON) M.M., D.M.A., or Certificate *Bassoon 481010 *Cello 481015 *Clarinet 481020 *Euphonium 481022 *Flute 481025 *Guitar 481030 *Horn 481040 *Oboe 481045 *Organ 481050 *Percussion 481055 *Piano 481060

*Piano Pedagogy 481061 *Saxophone 481063 *String Bass 481065 *Trombone 481070 *Trumpet 481075 *Tuba 481080 *Viola 481085 *Violin 481090 *Voice 481095 *Woodwinds M.M., Certificate 481098Music Theory (CON) M.M. 419000

School of DentistryDental (DEN)***Advanced Education in General Dentistry (DEN) Certificate 033000 (Summer session admission only. Application deadline is Oct. 1.)Dental Hygiene Education (DEN) M.S. 168000 *Research (Fall semester admission only. Application deadline

is Feb. 1.)***Dentistry D.D.S. 170000 (Fall semester admission only. Application deadline is Nov. 1.)***Endodontics (DEN) Certificate 204000(Summer session only. Application deadline is Aug. 15.)***Oral Biology (DEN) M.S. 458000***Oral and Maxillofacial Surgery (DEN) Certificate 461000 (Summer session admission only. Application deadline is Aug. 15.)***Oral and Maxillofacial Radiology Certificate 459300***Orthodontics and Dentofacial Certificate 463000 Orthopedics (DEN) (Summer session admission only. Application dead-

line is Sept. 5.)***Pediatric Dentistry (DEN) Certificate 479500 (Summer session admission only. Application deadline is Oct. 15.)***Periodontics (DEN) Certificate 483000 (Summer session admission only. Application deadline is Sept. 1.)

School of EducationCounseling and Guidance (EDU)(Application deadline is March 1 for Fall admission and Sept. 1 for Spring.) *Couples and Family Counseling M.A., Ed. Sp.149050 *Mental Health Counseling M.A., Ed. Sp. 149010 *School Counseling and Guidance Ed. Sp. 149070 *Elementary M.A. 149040 *Secondary M.A. 149080Counseling Psychology Ph.D. 149500(Fall semester admission only. Application deadline is Jan 1. )Curriculum and Instruction *General M.A. 153024 *Curriculum Theory and Leadership Ed. Sp. 153013 *Early Childhood M.A., Ed. Sp. 153015 *Elementary M.A. 153020 *Elementary or Middle School Specialty Ed. Sp. 153019 *Multicultural Education M.A., Ed. Sp. 153091 *Subject Specialty M.A., Ed. Sp. 153080 *Teaching English as a Second Language M.A. 153085 *Learning Technologies M.A. 153095Educational Administration *General M.A., Ed. Sp. 192000 *Elementary School Admin. M.A., Ed. Sp. 192030 *Higher Ed. Admin. M.A. 192060 (Fall semester deadline is March 1. Spring semester

deadline is Oct. 1.) *Secondary School Admin. M.A., Ed. Sp. 192075 (Fall semester deadline is July 1. Winter semester

deadline is Nov. 1. Summer session deadline is April 1.) *Doctorate in Education Administration Pre K-12

EdD. 189001 (Application deadline is Aug. 1, 2007, for Winter 2008.)Reading Education (EDU) M.A., Ed. Sp. 734000Special Education (EDU) M.A. 780000

School of Graduate Studies***Interdisciplinary Leadership and Disability Studies (GRAD) Certificate 337000***Interdisciplinary Ph.D. Program (GRAD) 405500 Students select and earn a Ph.D. in two or more disciplines. Participating disciplines: Art History Cell Biology and Biophysics Chemistry Computing-Telecommunications and Networking Computing-Computer Science Computing-Computing and Electrical Engineering Curriculum and Instruction Economics Engineering English Entrepreneurship and Innovation Geosciences History Mathematics Molecular Biology and Biochemistry Music Education Oral Biology Pharmaceutical Sciences Pharmacology Physics Psychology Public Affairs and Administration Religious Studies Social Science Consortium Sociology Urban Leadership and Policy Studies in Education

School of Law***Law (LAW) L.L.M. 368000 **Estate Planning **Urban, Land Use and Environmental Law **Litigation **Business and Entrpreneurial Law***Juris Doctor (LAW) J.D. 352000***Taxation (LAW) L.L.M. 801000***Urban Affairs (LAW) L.L.M. 817000

School of MedicineMedicine with Advanced Standing (MED) M.D. 393000 (Spring semester admission only. Application deadline

is Aug.1.) Anesthesiology (MED) M.S.A. 393001 (Application deadline is Jan. 5.)

School of NursingNursing (NUR) M.S.N. 438000 (Application deadline is Feb. 1 for Fall admission and Sept. 1 for Spring.)Nursing Cooperative Programs (NUR) Ph.D. 438020 (Application deadline is Feb. 1 for Fall admission only.)

School of PharmacyPharmaceutical Sciences (PHA) M.S. 487500 *Pharmaceutical Chemistry 487520 *Pharmacology 487560 *Toxicology 487590 (Application deadline is March 1.) Pharmacy (PHA) Pharm.D. 490000(Fall semester admission only. Application deadline is Jan. 15; special application packet required.)


UMKC Application for Six-Year B.A./M.D. Program Office of Admissions • University of Missouri-Kansas City • 120 Administrative Center • 5100 Rockhill Road • Kansas City, MO 64110-2499 Location Address: 5115 Oak St. • 816-235-1111 or 1-800-775-UMKC (8652) • FAX 816-235-5544 • www.umkc.edu/admissions

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General instructions• Pleasereadtheseinstructions

andadmissionscriteriabeforecompletingthisapplication.

• Pleasetypeorprint.• Applicantsareencouragedtoapply

wellbeforeadmissionsdeadlines.• Refertodepartmentsforspecial

deadlines.• Notespecialadmissionspacketsand

requirementsforcertainacademicprograms.CalltheUMKCacademicunitforcompleteinformation.

• Allapplicationsmustbeaccompanied byanonrefundable$35applicationfee.A$50applicationfeefornon-residentsapplyingtothesix-yearB.A./M.D.programisalsorequired.Applicationscannotbeprocessedwithoutfees.Pleasesendchecksormoneyordersonly.Onlineapplicantsmaypaybycreditcard.

• Applicantswhodonotmeetadmissions criteriamaypetitionforadmissionbycontactingtheOfficeofAdmissions.

• A2.0GPAona4.0scaleisrequiredofallcollege-levelcourseworkforfreshmanapplicantswhohavecompletedcollegecredit.

Additional Information• RefertotheRegistrationGuideand

UMKCcatalogforinformationonfees,refundsandclassschedulechanges.

• AlltranscriptssubmittedinsupportofanapplicationbecomethepropertyofUMKC.

Freshman Admission ApplicantsforadmissiontoYear1ofthesix-yearmedicalprogrammustfirstbeacceptedintoUMKC.AdmissionisselectiveandisdeterminedbyacombinationofclassrankandACTscore,aswellascompletionofthefollowingcriteria:

• GraduationfromanaccreditedUnitedStateshighschoolwithcurriculumincluding:

(oneunitequalsoneyearinclass) • fourunitsofEnglish • fourunitsofmathematics

(algebraIorhigher) • threeunitsofscience,includ-

ingoneunitofbiologyand oneunitofchemistry

• threeunitsofsocialstudies • oneunitoffinearts(visual

arts,music,danceortheater) • twounitsofthesameforeign

language • one-halfunitofacomputer

sciencecourseisrecom- mendedbythemedical school.

TheschoolstronglyencouragesprospectivestudentstoearncreditthroughAdvancedPlacement(AP)courses,ifavailable,inmath,English,EuropeanhistoryorAmericanhistory.

Ifyourhighschooldoesnotofferbiology,chemistryorforeignlanguage,contacttheCouncilonSelectionattheSchoolofMedicineat816-235-1870orwriteto:CouncilonSelection,UMKCSchoolofMedicine,2411Holmes,KansasCity,Mo.64108

• U.S.citizenshiporpermanentresidentstatusbyNov.15oftheyearprecedingthefalltermforwhichyouareapplying.Acopyofthepermanentresidentcardmustaccompanyyourapplication.

• Demonstrationofabilitytoperformsuccessfullyatthecollegelevel,particularlyinUMKC’ssix-yearprogram,asevidencedbyacombinationofhighschoolclass

rank,ACTscoreandcompletionoftheACTStudentProfile

• PerformanceontheToledoChemistryTest(administeredattimeofinterview)

• Personalcharacteristicssuchasselfawareness;leadershipandteamworkability;timemanagementandproblemsolvingskills,lifelonglearning;motivation;respect,compassionandempathy,communicationskillsandanunderstandingofdiversityand socialcontext.

• SubmissionoftheYear1medicalschoolapplicationthatincludesapersonalstatement,activitysheetandlettersofrecommendation

Missouri Residents TheaverageacceptedMissouriapplicanthasanACTscoreof29andarankwithinthetop10%ofthegraduatingclass

Regional and Out-of-State Residents

Theaverageacceptedregionalorout-of-stateapplicanthasanACTscoreof30andarankwithinthetop5%ofthegraduatingclass.

Applicants With Some College Credit Studentsmayapplyaftergraduationfromhighschoolprovidedtheyhavenomorethan24hoursofposthighschooldiplomacollegecreditatthetimetheirapplicationissubmittedtotheAdmissionsOffice.TheseapplicantswillbereviewedwiththesamecriteriaasotherYear1applicants.

Iftheapplicantiscurrentlyenrolledincollegethesemestertheyapplytothesix-yearprogram,thenumberofhoursaccumulatedattheendofthatsemestermustnotexceedthe24-hourlimit.Applicantsmaycontinueincollegethenextsemesterwhiletheirapplicationisbeingprocessed.

Applicantsmusthavea3.0GPAorhigherforallcollegecreditattemptedorearned.Officialcollegetranscriptsmustbesubmittedalongwithotherapplicationmaterials.AcurrentACTtestwithinthelastthreeyearsisrequired.

Applicantswithmorethan24hoursofcollegecreditmayqualifyasanM.D.-onlyapplicant.

M.D.-Only Applicants Positionsmaybecomeavailablebetweenthesecondandthirdyearoftheprogram.Applicationswillbeconsideredfrombothin-stateandout-of-stateresidentswhoholdatleastabaccalaureatedegree.AminimumcumulativeGPAof3.0isrequired.M.D.-onlystudentsentertheSchoolofMedicineandbegintheircurriculuminthespringsemesterofYear2oftheprogram.TheapplicationdeadlineforJanuaryentryintotheM.D.-onlyprogramisAug.1oftheprecedingyear.

Ascoreof24orbetterontheMCATispreferred.BasedontherevisedMCATscheduleeffectiveJanuary2007,applicantsarestronglyencouragedtotaketheMCATnolaterthanJune15.ScoresfromlateradministrationsmaynotbeavailableintimetobeconsideredforthefollowingJanuaryadmission.

Applicantsmusthaveaminimumof19hoursofchemistrythatincludestwosemestersofgeneralchemistry,onesemesteroforganicchemistryandonesemesterofbiochemistry(a300or400-levelcoursewithagradeofBoraboveisrequired.Humanbiochemistryrecommended,asa300-levelcourseorabove).

Studentsmustalsohaveaminimumof14hoursofbiologythatincludesonesemesterofgeneralbiologywithlab,onesemesterofgeneticsandonesemesterofcellbiology.M.D.-onlyapplicantsarealsostronglyencouragedtoenrollinonesemesterofmicrobiologywithlabandonesemesterofintroductoryanatomywithlab.Coursesinphysicsandalgebra/calculusarealsostronglyencouraged.

Ready to apply?Complete the online application available at www.umkc.edu/admisssions orbring your application to room 120, in the UMKC Administrative Center at 5115 Oak St. ormail your application, test results and all transcripts to:University of Missouri-Kansas City, Office of Admissions, 120 Administrative Center, 5100 Rockhill Road, Kansas City, MO 64110-2499


UMKC Application for Six-Year B.A./M.D. ProgramReport of Required High School Coursework Apply online at www.umkc.edu/admisssions.

New freshmen and transfer students with fewer than 24 hours of college-level coursework must complete this form.

Lastname First Middle SocialSecuritynumber

Highschoolname Phonenumber

Highschooladdress City State ZIP

Required subject areas and typical examplesYou are encouraged to consult your counselor to determine which courses to list in each area.

Four units of English(One may be in speech or debate; two that emphasize composition or writing skills are required.) English 9, 10, 11, 12; English literature, speech, debate, journalism, etc. Not acceptable: yearbook, acting, theater, drama, business English, media

Four units of mathematicsalgebra I, geometry, algebra II, pre-calcu-lus/trigonometry/analytic geometry, calculus, math analysis, etc. Not acceptable: computer math, programming, consumer math, pre-algebra, accounting, basic math, technical math, computer science

Three units of science (One unit of biology and chemistry is required. One unit must be a laboratory course.) earth science, physics, etc. Not acceptable: general science, vo-ag or agricultural science

Three units of social studiesworld history, American history, American government, principles of democracy, etc.

One unit of fine artsart, music, drama, dance. Not acceptable: allied arts, literature, foreign language, speech, debate

Two units of a single foreign languageThis requirement may be satisfied by the completion of courses in middle school, junior high or senior high; or by a passing score on a proficiency examination.

Completed courseworkEnter the names of the courses completed. One unit = one year in class

Grade Units

Coursework in progressEnter the names of all other courses to be completed before graduation.

Units

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UMKC Application for Six-Year B.A./M.D. Program Print or type information. Apply online at www.umkc.edu/admisssions.

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General information m Midwest Student Exchange Program

SocialSecuritynumber Lastname First Middle Other(Maiden)

Currentlegaladdress:numberandstreet City State ZIP County

Currentmailingaddress:numberandstreet City State ZIP County

Homephone Cellphone Workphone

Dateofbirth:month/day/year E-mailaddress

Any student under age 21 and financially dependent on a parent or guardian must complete the following:

Mother’sname E-mail

Address City State ZIP

Father’sname E-mail

Address City State ZIP

Residency informationAre you a Missouri resident? m Yes m No Placeofbirth:City State

How long have you been a Missouri resident?

PreviousLegalAddress,iflessthanoneyearinMissouri:City County State

Are you a legal resident of Johnson, Leavenworth, Miami or Wyandotte county in Kansas? m No m Yes, how long?Are you a U.S. citizen? m Yes m No, country of citizenship

Ifresidentalien,cardnumber DateofissueAttach a copy of your card.

Note: If you are an international visa student (nonresident alien), do not use this form.

Enrollment informationHave you ever applied to UMKC before? m No m Yes, semester and year applied:Have you previously enrolled at UMKC? m No m Yes, last semester enrolled:Which semester and year will you enter UMKC? m Fall 20____ m Spring 20____ m Summer 20____What will be your entering status? m New freshman m Transfer m Graduate m Second-degree-seeking (undergraduate post-bachelor) m Nondegree-seeking (nondegree-seeking students are not eligible to receive financial aid)

Do you plan to complete a degree at UMKC? m Yes m NoBriefly describe your educational goals:

Optional information Gender and ethnic origin are requested for purposes of federal compliance reporting. Gender: m Male m Female Ethnic Origin: m American Indian or Native Alaskan m Asian m White, Non-Hispanic m Black, Non-Hispanic m Hispanic or Latino m Native Hawaiian or other Pacific IslanderAre you or your parents employed by the University of Missouri? m Yes m NoDid one or both of your parents graduate from college? m Yes m No Did one or both of your parents/grandparents graduate from UMKC? m No m Yes, name: First Last (Maiden)Religious preference (Not combined with federal compliance. May be sent to campus ministry organizations.)

Educational information

Highschoolattended City State

Dateof(anticipated)graduationorGEDdiploma GEDscore xx

continued on other side


UMKC Application for Six-Year B.A./M.D. ProgramEducational information, continuedName and location of all colleges and universities attended prior to enrollment at UMKC, including dates of attendance and degrees earned or expected. Include all colleges or universities from which you have earned dual credit. Please request all colleges and universities send official transcripts of coursework. Failure to indicate schools in which you have been enrolled will void your admission. Attach list if necessary.

Name of school Location Dates of attendance Degree earned/anticipated

Freshman and transfer students (with fewer than 24 hours): Have you taken the ACT? m Yes m No If yes, have you requested your score to be sent to UMKC? m Yes m No

Selecting a major, degree program and schoolAll students should refer to the UMKC Degree Programs List and carefully select the appropriate program as listed. We only offer degrees in those programs on the list. If you don’t select from the list of degrees, you will be placed in the program that corresponds with your educational goals and qualifications.

Intended academic major and six-digit code: 393000 Baccalaureate M.D. Program ______________________________________________________________________

If not admitted to the Baccalaureate M.D. Program program indicate your second choice of degree program, choosing from the list on pages 1 and 2:

___________________________________________________________________________________________________________

Students may also complete a Pre-Medicine track at UMKC to prepare for a more traditional medical program. If you are interested in Pre-Medicine as your second option for a degree track, check your choice below.m Biology Pre-Medicine (School of Biological Sciences)m Pre-Medicine/Health Programs (College of Arts and Sciences) indicate major:m Other: ___________________________________________________________________________________________________

Read carefully: I certify the information on this application is accurate and complete, and I understand that all required credentials must be submitted before an admission decision can be made. I authorize the University of Missouri-Kansas City to maintain all my records under my signed name, and I understand these records and credentials in support of my application are the property of UMKC and may not be returned or reproduced.

___________________________________________ __________________________________________________Date Signature

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Supplemental Application Form —Year 1Applicant information (please print or type)

SocialSecuritynumber Lastname First Middle Other

Homephone Workphone Cellphone

Currentlegaladdress:numberandstreet City State ZIP County

Currentmailingaddress:numberandstreet City State ZIP County

Dateofbirth _____________________________Birthcountry ________________________________E-mail ____________________________

AreyouaMissouriresident? m Yes m No Placeofbirth ____________________________________________________________________ City State CountyHowlonghaveyoubeenaMissouriresident? _____________________________________________________________________________________

AreyouaU.S.citizen? m Yes m No Ifno,countryofcitizenship ________________________________________________________________

Ifresidentalien,cardnumber ________________________________________________________ Dateofissue _______________________________Attachacopyofyourcard.Note: If you are an international visa student (nonresident alien), do not use this form.

Applicantsmusthaveatleastthreereferencesandnomorethansix.

Referee name Title E-mail address Phone number

HowdidyoufindoutaboutthecombinedBaccalaureate-M.D.programatUMKC?Pleasecheckasmanyasapply:m Brochure m Studentsatothermedicalschoolsm MedicalstudentsatUMKC m UMKCMedicalSchoolalumnim Familyphysicians m Familyfriendm Internet m Familymemberwas/isinprogram(sibling,cousin,parent,etc.)m Highschoolcounselors m Other–pleaseexplain_________________________

Educational information

______________________________________________________________________________________________________________________Highschoolname Yearofgraduation

______________________________________________________________________________________________________________________Highschoolcityandstate Highschoolphonenumber

Areyoucurrentlyenrolledasafreshmanincollege?m Yes m NoIfyes,where?_______________________________

Haveyoutakencoursesforcollegecredit?Ifso,fillintheboxesbelow:

Course name Number of credit hrs.

AP (Advanced credit)

IB (International baccalaureate

Dual Credit Other college credit

(example) English 110 3 X

Areyouinterestedinbeingconsideredforascholarship?(requiresthatapplicantcompleteaFAFSA–Freeapplicationforfederalstudentaid).m Yesm No

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m Firsttimeapplying m Re-applying

(continued on back)


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Educational information (continued)

Whatisthehighestlevelofformaleducationobtainedbyyourparents?(Markwithan“X”intheappropriatespace.)

Father Mother Father’sname ___________________________________________Gradeschoolorless _____ _____Somehighschool _____ _____ Occupation _____________________________________________Highschoolgraduate _____ _____Somecollege _____ _____ Mother’sname __________________________________________Collegedegree _____ _____Post-graduate _____ _____ Occupation _____________________________________________

Numberofsisters __________ Ages ______________________

Numberofbrothers _________ Ages ______________________

E-Consent

E-ConsentforSchoolofMedicineSelectionprocessgivespermissionfortheUMKCSchoolofMedicineOfficeofSelectiontoexchangee-mailswithyouregardingpersonspecificinformation.Youhavetherighttoreceiveyourinformationinprintedformat.However,withyoure-Consent,yourtransactionscanbeprocessedfasterthanifyouhavetowaitformailfromourofficesorconductbusinessinperson.Thechoiceisyours.YoumustreadandagreetothefollowinginformationandconditionsinordertocompletetheUMKCSchoolofMedicinee-Consentprocess.Youmaywithdrawyoure-ConsentatanytimebysendingarequesttotheUMKCSchoolofMedicineOfficeofSelection,2411HolmesSt.,KansasCity,MO64108-2792.Ifyoudonotconsent,youshouldknowthat:•AllcorrespondencewillbesentthroughtheU.S.PostalService,whichmaydelayprocessing.•Noe-mailexchangesbetweenyouandstafftheSchoolofMedicineOfficeofSelectionwillbeconsideredoffical.•Evenifyoudesignatesomeoneasauthorizedtoaccessyourinformation,noe-mailexchangesbetweenthemandstaffintheSchoolofMedicineOfficeofSelection

willbeconsideredofficial.•Allrequestsmustbemadeinwritingorinperson.•IfyourmailingaddressisnotkeptcurrentwiththeUniversity,youmayexperiencesignificantdelays.

Pleasecheckoneandsignbelowm Igivemye-Consentfortheaddressconfirmedhere_______________________________(mustmatche-mailonpreviouspage)m Idonotgivemye-Consent

___________________________________________ __________________________________________________Date Signature

Supplemental Application Form —Year 1


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Print or type information.

Personal statement Whathasmotivatedyoutostudymedicine?WhydoyouthinktheUMKCSchoolofMedicineshouldchooseyou?(Limitresponseto500wordsorless.)

Additional short answer responses Whatisyourgreateststrength?Whatisyourgreatestweakness?Howwouldtheseaffectyourabilitytosucceedinmedicalschool?: _______________________

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Describeatimewhenyoudisagreedwithagradeorevaluation.Whatdidyoudoandwhy?: ____________________________________________________

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Describeatimewhenyouwereingroupconflict.Whatwastheproblemandhowdidyouhandleit?: ______________________________________________

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Describeanexperienceinwhichyouinteractedwithpeoplewhoaredifferentfromyou.Whatdidyoulearnfromit/them?: _______________________________

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Whatbookshaveyoureadforinterest/pleasurerecentlyandwhy?: ______________________________________________________________________

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Medicineisdefinedasafieldoflife-longlearning.Whatdoesthismeantoyou?: ____________________________________________________________

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________________________________________________________________________________________________________________________SocialSecuritynumber Lastname First Middle Other

Nameofactivity(pleasedonotuseacronyms) Datesofparticipation Hours/weekdevotedtoactivity

Typeofactivitym Schoolrelatedm Communityrelated(churchetc.)m Volunteerismm Healthcare/shadowingexperiencem Workexperience

Descriptionofinvolvmentinactivity:

Leadershiprole,ifany:

Whatandwhomotivatesyoutobeinvolvedinthisactivity?

Howdoyouthinkthisactivitypreparedyouformedicalschool?













Return completed form with your application. (Copy as needed up to four times for a total of no more than 15 activities.)

High School Activity Sheet Print or type information.


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Technical STandardS

This form must be completed and returned to the UMKC Office of Admissions, 120 Administrative Center, 5100 Rockhill Road, Kansas City, MO 64110-2499 before your application will be reviewed further. The deadline for our receipt of this form is Nov. 1, 2008.

____________________________________________________________________________________________________________SocialSecuritynumber Lastname First Middle Other

Because of our obligation to ensure that patients receive the best medical care possible, certain abilities are required of our students. All students of medicine must possess those intellectual, emotional and physical capabilities which are necessary to participate fully in the curriculum and which are essential to achieve the levels of competence required by the faculty.

Candidates for the medical degree must be able to observe and perform a variety of procedures. Intact sensory and motor functioning is required for accurate observation and the competent performance of procedures. Candidates must be able to observe and evaluate a patient accurately, at a distance and close at hand. This necessitates the functional use of the senses of vision, hearing, touch and sometimes smell. A candidate must be able to communicate effectively, to hear and to observe patients in order to elicit information, describe changes in mood, activity and posture, and perceive nonverbal communications. The candidate must be able to communicate effectively in oral and written form. Candidates must have sufficient motor function to elicit information from patients by palpitation, auscultation, percussion and other diagnostic maneuvers.

Problem solving is a critical cognitive skill demanded of physicians, and it requires the intellectual abilities of measurement, calculation, reasoning, analysis and synthesis. In addition to these skills, a candidate must possess the high moral and ethical standards demanded of physicians and the emotional health required for full utilization of his or her intellectual abilities, the exercise of good judgment, the prompt completion of all responsibilities attendant to the diagnosis and care of patients, and the development of mature, sensitive and effective relationships with patients.

Because of the above essential functions, the School of Medicine strongly discourages the use of surrogates to perform these functions as a reasonable accommodation for persons with disabilities. While each application is reviewed individually, it is necessary that each degree candidate himself or herself be able to observe and perform each task required by the curriculum of the school. Similarly, the school does not consider the waiver of required examinations a reasonable accommodation for individuals with learning disabilities. Learning-disabled students, when appropriate,* may be granted additional time on required examinations, be examined in separate testing facilities or accommodated in other reasonable ways, but they will not be exempted from the requirement to take and pass such examinations.

The University of Missouri-Kansas City School of Medicine has a standing committee to review qualified applicants who are unable to meet the technical standards for admission as stated above. The entire application file will be formally reviewed by this standing committee of the Council on Selection in consultation with the UMKC Office of Disabled Student Services.

*Contact the UMKC Office of Disabled Student Services for information regarding definition and documentation of learning disabilities.

I have read and understand the above technical standards, and I hereby certify that I believe that I am able to meet these standards if I become a medical student at the University of Missouri-Kansas City School of Medicine. CHECK ONE: m Yes m No

___________________________________________ __________________________________________________Date Signature


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Office of AdmissionsUniversityofMissouri-KansasCity120AdministrativeCenter5100RockhillRoadKansasCity,MO64110-2499Location Address: 5115 Oak St.816-235-1111or1-800-775-UMKC(8652)FAX816-235-5544www.umkc.edu/admit

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reference formUMKC SChool of MediCine BaCCalaUreate-M.d. degree PrograM

APPLICANT:Youarerequiredtosubmitthreereferencesfromteachersofacademicsubjects,counselorsorschooladministratorswhocaninformusasthoroughlyaspossibleonyouracademicandpersonalqualitiesandachievementsasatotalperson.Allreferencesaretobesubmittedusingthisform.

Please complete the top portion of the form, then give it to your referee for completion.

Iwaivetherighttoinspectthisconfidentialrecommendation.Iunderstandthat,accordingtotheFamilyEducationalRightsandPrivacyActof1974, thiswaiverisoptional.

___________________________________________________________________________________________________________________SocialSecuritynumber Lastname First Middle Other

___________________________________________________________________________________________________________________E-mail Dateofbirth

___________________________________________________________________________________________________________________Homephone Workphone Cellphone

Signatureofapplicant ________________________________________________________ Date ______________________________________

Printnameofreferee ___________________________________________________________________________________________________

REFEREE:Theinformationsuppliedonthisformwillbeusedforthepurposeofassessingtheapplicant’squalificationsforadmission.Yourcommentswillbe heldcompletelyconfidentialiftheapplicanthassignedthestatementabove. ThedeadlineforacceptingthesereferencesisNov. 1, 2008.

Pleasemailthisformdirectlyto:Office of Admissions, University of Missouri-Kansas City, 120 Administrative Center, 5100 Rockhill Road, Kansas City, MO 64110-2499.

1. Howlonghaveyouknowntheapplicant?______Years______Months Inwhatcapacity? ___________________________________________________________________________________________________(indicatesubjectmatterifteacher)

2. Doyouknowofanythingthatreflectsadverselyontheapplicant’smoralcharacter?Ifso,pleaseexplain:(Attachaseparatesheetifdesired.) ____________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

3. Doyouknowofanyemotionaldifficultiesexperiencedbytheapplicant? _____________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

4. Doyoufeelthattheapplicantwouldbeabletoadjusttothedemandsofanintensiveyear-roundeducationalprogramwithoutunduedifficulty? __________

Ifnot,pleaseexplain: ________________________________________________________________________________________________

________________________________________________________________________________________________________________

The UMKC School of Medicine’s combined Baccalaureate–M.D. Degree is a unique program. If you are not familiar with our program, visit our Web site at www.med.umkc.edu.

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5.Pleaseratetheapplicant’sachievementandpotentialbyenteringan“X”intheappropriatespacesbelow,comparing the applicant with others in his or her class and age group:

Outstanding Above average Average Below average No knowlege

Self awarenessRespondswelltocriticism

Self awarenessToleranceofanxiety

Self awarenessKnowsownstrengthsandweaknesses

Leadership and teamworkAbilitytoworkwithothers

Time managementOrganizationanduseoftime

Diversity and social contextOpenesstopeopledifferentfromthemselves

Diversity and social contextTolerationofopposingviews

Respect, compassion and empathyWillingnesstoputthelegitimateneedsofothersaheadoftheirownpersonalneeds

Respect, compassion and empathyOrientedtoservingotherpeopleinsteadofoneself

Problem solvingAbilitytomakedecisions

Problem solvingAbilitytoresolveconflict

Problem solvingGeneralresourcefulness

Life long learningTimespentinselfeducation

Life long learningGeneralcuriosity

MotivationCommitmenttocareerinmedicine

Communication skillsEffectiveexpressionofthoughtsandabilities

Communication skillsAbilitytolistenattentively

Knowledge of the sciences

6. Ifyouwishtoaddanycomments,pleaseusethisspace: _____________________________________________________________________________

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________________________________________________________________________________________________________________________

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________________________________________________________________________________________________________________________

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7.Pleasecheckone: m Recommend enthusiastically m Recommend m Recommend with reservations m Do not recommend

Print name: ______________________________________________

Signature: _______________________________________________ Date: ___________________________________________________________

Institution: _______________________________________________ Position: ________________________________________________________



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Important Contacts

Admissions 816-235-1111 or 1-800-775-UMKC (8652)www.umkc.edu/admissions

Bookstore816-235-2665www.umkcbookstore.com

Career Services 816-235-1636www.career.umkc.edu

Cashier’s Office816-235-1365www.umkc.edu/adminfinance/finance/cashiers

Campus Tours 816-235-UMKC or 1-800-775-UMKC (8652)

Campus Information 816-235-5555

Class Scheduler816-235-1213www.umkc.edu/sched

Events Hotline 816-235-1212

Financial Aid and Scholarships816-235-1154 or 1-800-775-UMKC (8652)www.sfa.umkc.edu

On-campus Housing Information 816-235-8840www.umkc.edu/housing

Student Life 816-235-1407www.umkc.edu/stulife

Welcome Center 816-235-UMKC or 1-800-775-UMKC (8652)

Statement of Human RightsThe Board of Curators and UMKC are committed to the policy of equal opportunity, regardless of race, color, creed, sex, age, national origin, disability, or Vietnam-era Veteran status. The Affirmative Action Office, 360 Administrative Center, 5115 Oak St., is responsible for all relevant programs. Call 816-235-1323 for information or go to www.umkc.edu/ad-minfinance/eoaa. People with speech or hearing impairments may contact the University by using Relay Missouri, 1-800-735-2966 (TT). Students’ Right to KnowIn accordance with Public Law 101-542, UMKC reports 73.1 percent of its first-time freshmen return the second year. The UMKC Police Department publishes an annual campus report on personal safety and crime statistics. The report includes statistics for the previous three years concerning reported crimes that occurred on campus; in certain off-campus build-ings owned or controlled by UMKC; and on public property within, or immediately adjacent to and accessible from the campus. The report also includes institutional policies concerning campus security, such as policies concerning alcohol and drug use, crime prevention, the reporting of crimes, sexual assault and other matters. The report is available at the UMKC Police Department, room 213, 4825 Troost Building, or online at www.umkc.edu/safetyreport.

an equal opportunity/affirmative action institution

University of Missouri-Kansas CityOffice of Admissions120 Administrative Center5100 Rockhill RoadKansas City, MO 64110-2499

816-235-1111 or 1-800-775-UMKC (8652)

[email protected]

www.umkc.edu/admissions


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