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Internship Program Packet

Section IRequirements and Application Criteria

Program Requirements Minimum of 3.25 cumulative GPA Ability to attend all general meetings Thursday nights 6pm Ability to attend annual Leadership Conference in August Complete minimum of 6 hours a month of general interning Attend at least 5 Physician Education Courses a year Attend at least one Summer Science Camp

Application Requirements Completed Application packet Letters of recommendation (One required second is optional) Photo of yourself (professional please) Current transcript Fall school schedule Completed Interview

Optional Materials Resume Cover Letter CV Letter addressing discrepancies in your application (such as, GPA, criminal

record, etc.)

Section IIIntern Application

Full Name Date of Birth Gender____________________________ ______________ _____________

Mailing Address ___________________________________________________________________

Home Phone Cell Phone Work Phone_______________________ ___________________ _________________

Ethnicity (Check all that apply)□ Hispanic □ Caucasian □Asian □ Native American or Alaska Native □ African

American □ Native Hawaiian or Pacific Islander

Citizenship □ U.S. Citizen □ Permanent Resident (Immigrant)

Criminal Record Please include any pending or previous criminal charges. Please include any

official disciplinary actions that have been taken against you in a post secondary institution.

Emergency Contact InformationRelationship:

□ Mother □ Father □ Guardian □ Partner □ FriendName Address______________________ ________________________________________Home Phone Number Cell Phone Number Work Phone Number______________________ __________________ __________________Email Address___________________________

Secondary Education InformationPrevious College or University Attended___________________________________________________________________

Dates attended Major(s) and Degree(s) Obtained___________________________ ____________________________________

Cumulative GPA______________

Current College or University___________________________________________________________________

Dates attended Major(s) and Degree(s) Obtained___________________________ ____________________________________

Year in School Anticipated Graduation Date Cumulative GPA____________ _______________________ ______________

Post Secondary Education InformationCareer Interest(s) Check all those that apply

□Medicine □ Dental Medicine □ Pharmacy □ Physician Assistant □ Physical Therapist □ Nursing □ Public Health/Global Health □ Other

If other please specify: ________________________

Briefly state your timeline for perusing one of the above interests (if you will take time off, when you plan on applying, etc.)

What have you done to prepare for pursuing the above career (List any clinical, volunteer, research experience, along with any certifications, extra classes, etc.)

If you took time off between your undergraduate degree and now please specify why and what you did during that time off:

Ancillary Experience: Community Service and Philanthropic activities Community Service Experience 1 Weekly time commitment ___________________________________________________________________

Contact Name and Information___________________________________________________________________Description:_______________________________________________________________________________________________________________________________________________________________________________________________

Community Service Experience 2 Weekly time commitment___________________________________________________________________

Contact Name and Information___________________________________________________________________Description:_______________________________________________________________________________________________________________________________________________________________________________________________ Community Service Experience 3 Weekly time commitment___________________________________________________________________


Community Service Experience 4 Weekly time commitment___________________________________________________________________


Ancillary Experience: Employment and paid/unpaid Internships Employer/Organization 1 Weekly time commitment___________________________________________________________________


Employer/Organization 2 Weekly time commitment___________________________________________________________________






Ancillary Experience: Research, Science related, and clinical activities (these could include, but are not limited to, bench-side research, clinical research, volunteering at a hospital, being a TA or LA for a class, etc.)

Activity 1 Weekly time commitment___________________________________________________________________








Discussion Questions: Please answer each in 200 words or less. All prompts must be address to constitute a completed application. Feel free to attach a separate paper with your typed responses

Please describe you future goals – these could be professional, personal, career, experience related, etc. Describe how these goals would be accomplished using this Internship.

Based on your future goals and the career path you wish to pursue what resources and opportunities do you need to be successful?

Think of instances over the past 5 years in which you have been in a group based activity or event. What role do you assume within a group? How do you contribute or show your worth within the group? Does this change based on the other members of your group? Ideally how a group does based activity function?

Letters of Recommendation:

You must include at least one letter of recommendation. A second letter is optional. Both must be from individuals who know you professionally/academically. Please do not submit letters that are from personal acquaintances. If the letter is from a personal acquaintance that must be disclosed in the letter. Letters should be delivered in a sealed envelope with the application.

Letters should include the following biographical information: Name of organization or program affiliated with the recommender Name and Title of the Recommender Contact information for Recommender including phone and email

Letters should address the following: Dates and length of time spent with the applicant Capacity in which the recommender and applicant are affiliated The content should include specific examples that demonstrate the integrity of

the applicant relative to others

Submitting an application without letters of recommendation will not cause the application to be considered incomplete. However, the Medadvance and SERI value references and highly recommend including at least one letter of recommendation with your completed application packet.

Signature and Consent of Privacy:

I, ________________________________, on the date of ____________________, consent that MedAdvance and the Scientific Education & Research Institute have consent and permission to privately review the information I release. MedAdvance and the Scientific Education & Research Institute are not responsible nor held accountable for any release of information, but by signing this, I do acknowledge that although they will respect my privacy to the best of their ability, I am fully responsible for the exchange of private information taking place.

Signature Date

Return of Application: Email scanned copy to Hogan Slack at [email protected] and Taylor DeLaura at

[email protected] o If you email a copy, please save the document as (your last name-App).

Mail completed copy to:

The Scientific Education & Research Institute9005 Grant St. Suite #100Thornton, CO 80229 USARe: MedAdvance Internship Application

Thank you for choosing to apply to MedAdvance; advancing the standards of tomorrow’s medical professionals. We will process your application as soon as our Executive Board is able to. If you have any questions, please contact Taylor DeLaura at [email protected]

mailto:[email protected]



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