Albert Einstein College of Medicine of Yeshiva University

1. Please describe any past involvement you have had with Einstein and related experiences.

2. I was accepted to medical school previously but chose not to matriculate. Please indicate the name of the school, the year, and your reasons for not matriculating.

3. I currently have a deferred enrollment at a medical or professional school. Please indicate where you have a deferral and explain why you are applying to Einstein now.

1. I plan to take a year off after graduating while I apply to medical school. Please explain what you intend to do during this year and provide confirmation of your plans once they are finalized.

1. "Have you been subject to any disciplinary or administrative action, whether expunged or not, during your undergraduate or graduate studies?"

2. "Have you been subject to any disciplinary or administrative action, whether expunged or not, while you were an undergraduate or graduate student?"

3. I have received a warning notice for a non-academic issue that did not result in disciplinary action. Please explain when, where, and why this occurred.

4. "I have experienced a disciplinary action and/or an administrative action, whether expunged or not, while in school. If yes, please answer the following questions."

5. How many warnings did you receive before an action was placed on your record? Please explain how this affected you.

6. I have pending disciplinary charges. Please explain in detail.

7. I have been convicted of a crime. Please explain the circumstances in detail.

8. Have you ever been prohibited or suspended from practicing in a professional capacity due to alleged misconduct? If so, please explain in detail.

9. "I have been subject to disciplinary and/or administrative action, whether expunged or not, while in school. (If yes, please answer the following questions.)"

10. I have pending disciplinary charges. Please explain the situation in detail.

11. "I have been prohibited or suspended from practicing in a professional capacity due to alleged misconduct. Please explain the circumstances in detail."

1. Please list the languages you speak (other than English) and indicate your level of fluency in each (beginner, moderate, advanced).

2. Did you take your last science course more than five years ago? If you answered "yes" to the previous question and have been away from coursework for more than five years, please explain your activities and any coursework you may have completed during this time. If your answer was "no," please write "NA" in the box below.

3. If your college or university has an Undergraduate Pre-Professional Advisory Committee and you have chosen not to request a letter from that Committee, please explain your reasons for this decision.

4. Have you participated in an Einstein Pathway Program during high school, college, or afterward? If you answered "yes" to the previous question, please name the program(s) and the year.

5. If you answered "yes" to having worked with us at an Einstein-affiliated hospital, will a letter from an Einstein faculty member be included in your evaluations? If so, please provide the name, title, and department of the letter writer.

6. Please use this space to share anything about yourself that you would like us to know. If you prefer not to write anything, please indicate "NA."

7. I have taken time off from school between high school and college. I have taken time off from school during my undergraduate years. I have taken at least a year off from school since graduating from college, including this year in which I am applying. I have taken and received credit for online core science courses (e.g., chemistry, biology, organic chemistry, physics, and mathematics) that were completed prior to the COVID-19 pandemic (before Spring 2020). I have previously applied to medical school. I have submitted an AMCAS application to Einstein in the past. I am or was a graduate student in the Graduate Programs in the Biomedical Sciences at Albert Einstein College of Medicine. I was previously accepted to medical school but did not attend. I was previously enrolled in medical school. I can confirm that I have fulfilled the Albert Einstein College of Medicine competencies for admission. I will have a baccalaureate degree by the time I matriculate into medical school. I currently hold a deferral from another medical, graduate, or professional school. I have received a grade of "F" during my college or graduate school years. I have received a grade of "D" during my college or graduate school years.

8. 1. I have received a grade of "W" during my college or graduate school years. 2. I have received a grade of "I" during my college or graduate school years. 3. As an undergraduate, I transferred from one college to another. 4. I have received a warning notice for a non-academic issue that did not result in disciplinary action. 5. I have been subject to disciplinary action and/or administrative action, whether expunged or not, while an undergraduate or graduate student. 6. I currently have pending disciplinary charges. 7. I have been prohibited or suspended from practicing in a professional capacity due to alleged misconduct.

9. Please list the languages you speak (other than English) and indicate your level of fluency for each (beginner, moderate, advanced). If you do not speak any other languages, please write "N/A."

10. Your PRIMARY RECOMMENDATION PACKET will be submitted by (select one): 2. If you indicated above that you will have "Two individual letters (up to 5 are allowed)," please provide the names, titles, and institutions of your letter writers; use a separate line for each. Please note that one letter must be from your MAJOR, and your second letter must be from a science faculty member (two science letters from two different faculty members in the same department are acceptable). If this does not apply to you, please write "NA" in the box below. 3. If you are a post-baccalaureate student (not a master's degree student), a letter or statement of "Good Standing" must be submitted either from your undergraduate college or university or included in your post-bac letter. Please indicate which of the two applies to you, along with the name, title, and school from which the letter has been submitted. If no letter or statement has been submitted, please indicate when such a letter or statement will be uploaded to the AMCAS Letter Writer. If this does not apply to you, please write "NA." 4. Did you take your last science course more than 5 years ago? 5. If you have an Undergraduate Pre-Professional Advisory Committee at your college or university and have chosen NOT to request a letter from that Committee, please explain why not.

11. Do you have a family member who is a current non-faculty employee of an Einstein/Montefiore affiliated hospital? 2. Do you have a sibling who is currently enrolled as a medical or graduate student at Einstein? 3. Do you have a family member who is currently a faculty member at an Einstein/Montefiore affiliated hospital? 4. Do you have a family member who is an alumnus of Einstein (MD, MSTP, or PhD degree only)? Please do not include the names of relatives who have only completed residency training here.

12. G. Is there anything else you would like to share with us? 1. Please use this space to tell us anything about yourself that you would like us to know. If you do not wish to write anything, please indicate "NA."

13. "I took time off from school between high school and college."

14. "I took time off from school during my undergraduate years."

15. "I have taken at least a year off from school since graduating from college, including the current year in which I am applying."

16. I have taken and received credit for online core science courses (e.g., chemistry, biology, organic chemistry, physics, and mathematics) that were completed before the COVID-19 pandemic (earlier than Spring 2020).

17. "I have previously applied to medical school."

18. "I have previously submitted an AMCAS application to Einstein."

19. "I am a graduate student in the Sue Golding Division of Albert Einstein College of Medicine."

20. "I was previously accepted to medical school but did not attend."

21. "I was previously enrolled in a medical school."

22. "I can confirm that I have met the competencies required by the Albert Einstein College of Medicine."

23. For admission, please refer to the application procedure and course requirements at (http://www.einstein.yu.edu/educatio…pplication-procedure/course-requirements.aspx). If you answered "no" to the above question, please explain. For example, if you plan to take pre-medical coursework in the upcoming summer, fall, or spring, please list the courses and specify when and where you will be taking them. If your answer was "yes," please write "NA" in the box below.

24. "I will have a Bachelor's degree by the time I enroll in medical school."

25. "I currently have a deferral from another medical, graduate, or professional school."

26. "I received a grade of 'W' during my college or graduate school years."

27. "I received a grade of 'I' during my college or graduate school years."

28. "I have received a warning notice for a non-academic issue that did not result in disciplinary action."

29. I currently have pending disciplinary charges.

30. "I have been prohibited or suspended from practicing in a professional capacity due to alleged misconduct."

31. Please provide the year your parent or guardian received their highest academic degree, the name of that degree, and the name of the school. If the highest level of education is high school or lower, please write "high school or less."

32. Please provide your race as indicated on your AMCAS application.

33. Please provide your ethnicity as you indicated it on your AMCAS application.

34. If you indicated above that you will have "two individual letters (up to five are allowed)," please provide the names, titles, and institutions of your letter writers, using a separate line for each. Please note that one letter must be from your major, and the second letter must be from a science faculty member (two science letters from two different faculty members in the same department are acceptable). If this does not apply to you, please write "N/A" in the box below.

35. If you are a Post-Baccalaureate student (not a Master's Degree student), please indicate whether a letter or statement of "Good Standing" has been included in your letter packet. If "yes," please provide the name, title, and school from which the letter was submitted. If "no," please indicate when such a letter or statement will be uploaded to the AMCAS Letter Writer. If this does not apply to you, please write "NA."

36. Have you taken your last science course more than five years ago?

37. Have you participated in an Einstein/Montefiore Pipeline Program during high school, college, or afterward?

38. If you answered "yes" to having worked with us at Einstein/Montefiore, will a letter from an Einstein/Montefiore faculty member be included in your evaluations? Please provide the name, title, and department of the letter writer.

39. Do you have a family member who is currently employed (non-faculty) at an Einstein/Montefiore affiliated hospital?

40. Do you have a sibling who is currently enrolled as a medical or graduate student at Einstein?

41. Do you have a family member who is currently a faculty member at an Einstein/Montefiore affiliated hospital?

42. Do you have a family member who is an alumnus of Einstein (holding an MD, MSTP, or PhD degree)?

43. Is there anything else you would like to share with us?

44. I have taken time off from school between high school and college. I have also taken time off during my undergraduate years. Additionally, I have taken at least a year off since graduating from college, including the current year in which I am applying. I have completed and received credit for online core science courses (e.g., chemistry, biology, organic chemistry, physics, and mathematics) that were taken prior to the COVID-19 pandemic (before Spring 2020). I have previously applied to medical school and submitted an AMCAS application to Einstein. I was a graduate student in the Sue Golding Division of Albert Einstein College of Medicine. Although I was accepted to medical school previously, I did not attend. I can confirm that I have fulfilled the Albert Einstein College of Medicine competencies for admission. If you answered "no" to the above question, please explain. For example, if you plan to take pre-medical coursework in the upcoming summer, fall, or spring, please list the courses and specify when and where you will be taking them. If your answer was "yes," please write "NA" in the box below. (3000 characters) I will have a baccalaureate degree by the time I matriculate into medical school. I currently hold a deferral from another medical, graduate, or professional school. I have received a grade of "F," "D," "W," or "I" during my college or graduate school years. As an undergraduate, I transferred from one college to another. I have received a warning notice for a non-academic issue that did not result in disciplinary action. I have been subject to disciplinary or administrative action, whether expunged or not, while an undergraduate or graduate student. I currently have pending disciplinary charges. I have been prohibited or suspended from practicing in a professional capacity due to alleged misconduct. Please provide the year your parent or guardian received their highest academic degree, the name of that degree, and the name of the school. If the highest degree is high school or less, please write "high school or less." If you were employed during the academic year, other than during winter and summer breaks, please indicate the number of hours you worked per week, describe your job, and explain why you were employed. Is there anything else you would like to share with us?

45. "I have taken and received credit for online core science courses (e.g., chemistry, biology, organic chemistry, physics, and mathematics) that were completed before the COVID-19 pandemic (earlier than Spring 2020)."

46. "I was previously enrolled in medical school."

47. I can confirm that I have fulfilled the Albert Einstein College of Medicine COMPETENCIES (http://www.einstein.yu.edu/educatio…pplication-procedure/course-requirements.aspx) for admission. If you answered "no" to the previous question, please explain. For example, if you plan to take pre-medical coursework in the upcoming summer, fall, or spring, please list the courses and indicate when and where you will be taking them. If your answer was "yes," please write "NA" in the box below.

48. "I will have a Bachelor's degree by the time I matriculate into medical school."

49. For example, if you plan to take pre-medical coursework in the upcoming summer, fall, or spring, please list the courses and indicate when and where you will be taking them. If your answer is "no," please write "N/A" in the box below.

50. I have taken time off from school between high school and college. I have also taken time off during my undergraduate years. Additionally, I have taken at least a year off since graduating from college. I plan to take time off this year while I apply to medical school. (Please answer "yes" if you are not a full-time student this year.) I have taken and received credit for online core science courses (e.g., chemistry, biology, organic chemistry, physics, and mathematics). I have previously applied to medical school and submitted an AMCAS application to Einstein. I am or was a graduate student in the Sue Golding Division of Albert Einstein College of Medicine. I was accepted to medical school previously but did not attend, and I was also previously enrolled in medical school. I can attest that I have fulfilled the requirements of the Albert Einstein College of Medicine.

51. "I have taken at least a year off from school since graduating from college."

52. I plan to take time off from school this year while I apply to medical school. Please answer "yes" if you are not a full-time student this year.

53. I have completed and received credit for online core science courses, such as chemistry, biology, organic chemistry, physics, and mathematics.

54. I can attest that I have fulfilled the requirements of the Albert Einstein College of Medicine.

55. I will have a Baccalaureate Degree by the time I matriculate into medical school. I currently hold a deferral from another medical, graduate, or professional school. I have received a grade of "F" during my college or graduate school years. I have received a grade of "D" during my college or graduate school years. I have received a grade of "W" during my college or graduate school years. I have received a grade of "I" during my college or graduate school years. As an undergraduate, I transferred from one college to another. I have received a warning notice for a non-academic issue that did not result in disciplinary action. I have been subject to disciplinary or administrative action, whether expunged or not, while an undergraduate or graduate student. I currently have disciplinary charges pending. I have been prohibited or suspended from practicing in a professional capacity due to alleged misconduct. Please provide the year that Parent/Guardian #1 received their highest academic degree and the name of that degree. If they completed high school or less, please write "high school or less." Please provide the year that Parent/Guardian #2 received their highest academic degree and the name of that degree. If they completed high school or less, please write "high school or less." Please provide the street, city, state, and zip code of the address for Parent/Guardian #1. Please provide the street, city, state, and zip code of the address for Parent/Guardian #2. If you were employed during the academic year, excluding winter and summer breaks, please indicate the number of hours you worked per week, describe your job, and explain why you were employed. There are several questions regarding your past involvement with Einstein, among others. Additionally, there is an optional essay prompt asking if there is anything else you would like to share (4000 character limit).

56. "I currently have pending disciplinary charges."

57. Please provide the year that Parent/Guardian #1 received their highest academic degree and the name of that degree. If the highest degree is high school or lower, please write "high school or less."

58. Please provide the year that Parent/Guardian #2 received their highest academic degree and the name of that degree. If the highest degree is high school or lower, please write "high school or less."

59. "Please provide the street address, city, state, and zip code for Parent/Guardian #1."

60. "Please provide the street address, city, state, and zip code for Parent/Guardian #2."

61. There is also an optional essay titled "Anything Else?" with a 4,000-character limit.

62. Please answer the following series of yes or no questions. For each "yes" answer, provide a brief explanation of 100 words.

63. I have taken and received credit for online courses. Please note that the College does not accept online courses that are not offered by (as opposed to approved by) your undergraduate or graduate institution. If you have taken online courses, please indicate which courses you took, where they were taken, and why you chose to take them online.

64. I have worked part-time or full-time for pay during the academic year while in college. Please indicate when you worked (e.g., freshman year), the months of the year you worked, and the number of hours. Briefly describe the work you did.

65. I have previously applied to medical school. Please list the schools and the year of your application, and describe the actions you have taken to improve your application.

66. I have previously submitted an AMCAS application to Einstein. Please note that if you have completed two prior applications, you are ineligible for reapplication. Indicate whether you completed the application process for Einstein, the year(s) you applied, and whether you were interviewed.

67. I am currently enrolled in the Sue Golding Graduate Division. Please indicate the year you enrolled, when you plan to take your qualifying examination, and the name of your mentor/department. It is required that your mentor write a letter of recommendation on your behalf. Additionally, I am currently enrolled as an undergraduate student at Yeshiva University. Please indicate the month and year you will graduate.

68. I was previously enrolled in a medical school. Please indicate the name of the school, the dates of your enrollment, and your reason for leaving.

69. I have not yet completed all of the required competencies. Please indicate which competencies you are missing, as well as when and how you plan to complete them.

70. "I will have a Baccalaureate Degree by the time I matriculate in medical school. If you will not have your degree, please explain why."

71. "I received a grade of 'W' during my college or graduate school years. Please indicate the name of the course and the reason for this grade."

72. "I received a grade of 'I' during my college or graduate school years. Please indicate the name of the course and the reason for this grade."

73. I anticipate that there will be pending criminal charges brought against me. Please explain in detail.

74. I have taken and received credit for online courses. Please note that the College does not accept online courses that are not offered by your undergraduate or graduate institution (as opposed to those that are merely approved). If you have taken online courses, please indicate which courses you completed, where they were taken, and why you chose to take them online.

75. I have previously applied to medical school. Please list the schools and the years of your applications, and describe the actions you have taken to improve your application.

76. I have previously submitted an AMCAS application to Einstein. Please note that if you have completed two prior applications, you are ineligible to reapply. Additionally, please indicate whether you completed the application process for Einstein, the year(s) you applied, and whether you were interviewed.

77. I am currently enrolled in the Sue Golding Graduate Division. Please indicate the year you enrolled, when you plan to take your qualifying examination, and the name of your mentor and department. Your mentor is required to write a letter of recommendation on your behalf.

78. I am currently enrolled as an undergraduate student at Yeshiva University. Please indicate the month and year of your expected graduation.

79. I anticipate that there will be criminal charges brought against me that are currently pending. Please explain in detail.

1. What unique life experiences, personal attributes, and perspectives will you contribute to the incoming class? Are there specific challenges or successes you have encountered? If you prefer not to write anything, please respond with "NA."

2. "I received a grade of 'F' during my college or graduate school years."

3. "I received a grade of 'D' during my college or graduate school years."

4. As an undergraduate, I transferred from one college to another. What motivated your decision to transfer, and how did that experience shape your academic and personal growth?

5. Please answer the following series of yes or no questions. Any "yes" answer requires a brief 100-word explanation. 1. Have you taken time off between high school and college? (Please explain your activities in detail, your reasons for taking time off, and include dates.) 2. Have you taken time off during your undergraduate years? (Please explain your activities in detail, your reasons for taking time off, and include dates.) 3. Have you taken at least a year off since college graduation? (Please explain your activities in detail, your reasons for taking time off, and include dates.) 4. Do you plan to take time off this year, after just having graduated, while you apply to medical school? (Please explain what you plan to do this year and provide confirmation of your plans when they are complete.) 5. Have you taken and received credit for online courses? (Please note that the College does not accept online courses that are not offered by, as opposed to approved by, your undergraduate or graduate institution. If you have taken online courses, please indicate which courses, where they were taken, and why you elected to take them online.) 6. Have you worked part-time or full-time for pay during the academic year while in college? (Please indicate when you worked, e.g., freshman year, what months of the year you worked, and how many hours. Briefly describe the work you did.) 7. Have you applied to medical school previously? (Please list the schools and year of application, and tell us what actions you have taken to improve your application.) 8. Have you submitted an AMCAS application to Einstein previously? (Please keep in mind that if you completed two prior applications, you are ineligible for reapplication. Please indicate whether you completed the application process for Einstein, the year(s) you applied, and whether you were interviewed.) 9. Are you presently enrolled in the Sue Golding Graduate Division? (Please indicate the year you enrolled, when you plan to take your qualifying examination, and the name of your mentor/department. It is required that your mentor write a letter of recommendation on your behalf.) 10. Are you presently enrolled as an undergraduate student at Yeshiva University? (Please indicate the month and year that you will graduate.) 11. Had you been accepted to medical school previously but chose not to matriculate? (Please indicate the name of the school, the year, and your reasons for not matriculating.) 12. Had you been enrolled previously in a medical school? (Please indicate the name of the school, the dates of your enrollment, and your reason for leaving.) 13. Have you not yet completed all of the competencies? (Please indicate what you are missing, and when and how you plan to complete them.) 14. Will you have a Baccalaureate Degree by the time you matriculate in medical school? (Please indicate why you will not have your degree.) 15. Are you presently holding a deferred enrollment to a medical/professional school? (Please indicate where you are holding a deferral and why you are applying to Einstein now.) 16. Have you received a grade of "F" during your college/graduate school years? (Please indicate the name of the course and the reason for the failure.) 17. Have you received a grade of "D" during your college/graduate school years? (Please indicate the name of the course and the reason for this grade.) 18. Have you received a grade of "W" during your college/graduate school years? (Please indicate the name of the course and the reason for this grade.) 19. Have you received a grade of "I" during your college/graduate school years? (Please indicate the name of the course and the reason for this grade.) 20. Have you transferred from one college to another during your undergraduate years? (Please explain why you chose to transfer and indicate the names of the colleges involved.) 21. Have you been the recipient of a warning notice for a non-academic issue that did not result in disciplinary action? (Please explain when, where, and why.) 22. Have you been subject to disciplinary action and/or administrative action, expunged or not, while in school? (If yes, please answer the following questions.) - Expunged? No Yes - How many warnings did you receive prior to an action being placed on your record? (Please explain how all of the above affected you.) 23. Do you have disciplinary charges pending? (Please explain in detail.) 24. Have you been convicted of a crime? (Please explain in detail.) 25. Do you expect that there will be criminal charges brought against you which are now pending? (Please explain in detail.) 26. Have you been prohibited or suspended from practicing in a professional capacity due to or as a result of alleged misconduct? (Please explain in detail.)

6. I have taken time off between high school and college. Please explain your activities in detail, your reasons for taking time off, and include the dates.

7. I have taken time off during my undergraduate years. Please explain your activities in detail, your reasons for taking time off, and include the dates.

8. I have taken at least a year off since graduating from college. Please explain your activities in detail, your reasons for taking this time off, and include specific dates.

9. "I received a grade of 'F' during my college or graduate school years. Please indicate the name of the course and the reason for the failure."

10. "I received a grade of 'D' during my college or graduate school years. Please indicate the name of the course and the reason for this grade."

11. I transferred from one college to another during my undergraduate years. Please explain why you chose to transfer and indicate the names of the colleges involved.

12. Please answer the following series of yes or no questions. Any "yes" answer requires a brief 100-word explanation. 1. I have taken time off between high school and college. (Please explain your activities in detail, your reasons for taking time off, and include dates.) 2. I have taken time off during my undergraduate years. (Please explain your activities in detail, your reasons for taking time off, and include dates.) 3. I have taken at least a year off since college graduation. (Please explain your activities in detail, your reasons for taking time off, and include dates.) 4. I plan to take time off this year, after just having graduated, while I apply to medical school. (Please explain what you plan to do this year and provide confirmation of your plans when they are complete.) 5. I have taken and received credit for online courses. (Please note that the College does not accept online courses that are not offered by, as opposed to approved by, your undergraduate or graduate institution. If you have taken online courses, please indicate which courses, where they were taken, and why you elected to take them online.) 6. I have worked part-time or full-time for pay during the academic year while in college. (Please indicate when you worked, e.g., freshman year, what months of the year you worked, and how many hours. Briefly describe the work you did.) 7. I have applied to medical school previously. (Please list the schools and year of application, and tell us what actions you have taken to improve your application.) 8. I have submitted an AMCAS application to Einstein previously. (Please keep in mind that if you completed two prior applications, you are ineligible for reapplication. Also, please indicate whether you completed the application process for Einstein, the year(s) you applied, and whether you were interviewed.) 9. I am presently enrolled in the Sue Golding Graduate Division. (Please indicate the year you enrolled, when you plan to take your qualifying examination, and the name of your mentor/department. It is required that your mentor write a letter of recommendation on your behalf.) 10. I am presently enrolled as an undergraduate student at Yeshiva University. (Please indicate the month and year that you will graduate.) 11. I had been accepted to medical school previously but chose not to matriculate. (Please indicate the name of the school, the year, and your reasons for not matriculating.) 12. I had been enrolled previously in a medical school. (Please indicate the name of the school, the dates of your enrollment, and your reason for leaving.) 13. I have not yet completed all of the competencies. (Please indicate what you are missing, and when and how you plan to complete them.) 14. I will have a Baccalaureate Degree by the time I matriculate in medical school. (Please indicate why you will not have your degree.) 15. I am presently holding a deferred enrollment to a medical/professional school. (Please indicate where you are holding a deferral and why you are applying to Einstein now.) 16. I have received a grade of "F" during my college/graduate school years. (Please indicate the name of the course and the reason for the failure.) 17. I have received a grade of "D" during my college/graduate school years. (Please indicate the name of the course and the reason for this grade.) 18. I have received a grade of "W" during my college/graduate school years. (Please indicate the name of the course and the reason for this grade.) 19. I have received a grade of "I" during my college/graduate school years. (Please indicate the name of the course and the reason for this grade.) 20. I have transferred from one college to another during my undergraduate years. (Please explain why you chose to transfer, and indicate the names of the colleges involved.) 21. I have been the recipient of a warning notice for a non-academic issue that did not result in disciplinary action. (Please explain when, where, and why.) 22. I have been subject to a disciplinary action and/or an administrative action, expunged or not, while in school. (If yes, please answer the following questions.) Expunged? No Yes How many warnings did you receive prior to an action being placed on your record? (Please explain how all of the above affected you.) 23. I have disciplinary charges pending. (Please explain in detail.) 24. I have been convicted of a crime. (Please explain in detail.) 25. I expect that there will be criminal charges brought against me which are now pending. (Please explain in detail.) 26. I have been prohibited or suspended from practicing in a professional capacity due to or as a result of alleged misconduct. (Please explain in detail.)

13. I took time off between high school and college. Please explain your activities in detail, your reasons for taking this time off, and include the relevant dates.

1. Have you ever volunteered at an Einstein-affiliated hospital in one of our clinical areas, other than research or a Pathway Program? If you answered "yes" to the previous question, please tell us where and when.

1. Have you worked in basic or clinical research at an Einstein-affiliated hospital? If you answered "yes" to the previous question, please specify where and when.

2. If you were employed during the academic year, excluding winter and summer breaks, please indicate the number of hours you worked per week, describe your job responsibilities, and explain the reasons for your employment.

3. Have you worked in basic or clinical research at Einstein/Montefiore? 2. Have you participated in an Einstein/Montefiore Pipeline (Pathway) Program during high school, college, or afterward? 3. Have you ever volunteered at Einstein/Montefiore in one of our clinical areas, other than research or a Pipeline Program? 4. If you answered "yes" to having worked with us at Einstein/Montefiore, will you include a letter from an Einstein/Montefiore faculty member in your evaluations?

4. In the list below and in the following question, please indicate the field(s) of your prior research experience. Check all that apply. 2. Please briefly describe the field(s) in which you plan to pursue future research. We are looking for the big picture—such as Aging, Neuroscience, Cell Biology, Immunology, etc.—not the specific focus. (250c) Please list your previous scientific presentations and abstracts, including all authors, abstract titles, name of the meeting, and date of the meeting. List each meeting on a separate line, and do not include the text of the abstract. (9999c) 3. Please list publications on which you are a co-author, with each listed on a separate line. Include the names of all authors, title, journal, year of publication, and volume and page number(s). Please do not list papers that are "in preparation." (9999c) 4. Please indicate which was your favorite course in college and explain why. (3000c)

5. Have you conducted basic or clinical research at Einstein/Montefiore?