Pre-Application for CPP-WesternU/CHS-DPT Linkage Program

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Email *

Last Name *

First Name *

CPP Major *

Bronco ID (needed to verify CPP status) *

Do you have legal US residency? *

Yes

Decline

Academic standing *

Freshman

Sophomore

Junior

Senior

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Total Semester Units Taken (Include transfer credits - students on quarter curriculum should convert quarter units into semester units by multiplying 2/3) *

Overall GPA (Including all courses taken - must be >= 3.3) *

Science/Major GPA (Including all major courses taken - must be >= 3.3) *

Please check all courses completed *

3 semester units or equivalent in English (ENG 1101 or ENG 1103 or ENG 2105 or GE A-3; or their equivalency)

6 semester units of Psychology with at least one taken from the Psychology department

1 - year of Biology (BIO 1210/L and BIO 1220/L)

1 - year of General Chemistry (CHM 1210/L and CHM 1220/L)

1 - year of Physics (PHY 1210/L and PHY 1220/L)

3 semester units of Human Anatomy with lab (BIO 2340/L)

3 semester units of Human Physiology with lab (BIO 2350/L)

3 semester units of Introductory Statistics (ATA 1200 or STA 1300)

None of the above

Decline

Required

Please check all courses that you have received a grade below C (C-, D+, D, D- or Fail) *

3 semester units or equivalent in English (ENG 1101 or ENG 1103 or ENG 2105 or GE A-3; or their equivalency)

6 semester units of Psychology with at least one taken from the Psychology department

1 - year of Biology (BIO 1210/L and BIO 1220/L)

1 - year of General Chemistry (CHM 1210/L and CHM 1220/L)

1 - year of Physics (PHY 1210/L and PHY 1220/L)

3 semester units of Human Anatomy with lab (BIO 2340/L)

3 semester units of Human Physiology with lab (BIO 2350/L)

3 semester units of Introductory Statistics (ATA 1200 or STA 1300)

None of the above

Decline

Required

Do you identify as minority? *

African Americans

Hispanics

Pacific Islanders

Native Americans

None of the above

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Required

Please choose any of the following that applies to you: *

You are from populations that are underrepresented in medicine and have a desire to return to practice in medically underserved areas

You grew up in a/an socio-economic, educational and/or medically underserved area/family and have a desire to practice in such communities/populations.

You have a strong history of outreach and community service, ideally with underserved populations or communities.

You have other experiences, skills or knowledge that can contribute to creating a well rounded and diverse healthcare workforce.

None of the above

Decline

Required

Please choose any of the following that applies to you: *

You are a person for whom English is not your primary language and for whom language is still a barrier to academic performance.

You come from a high school where at least 30 percent of enrolled students are eligible for free or reduced price lunches.

You come from a school district where 50 percent or less of graduates go to college within one year of graduation

You are a person who is in the first generation of your family to attend college.

You come from a city with a population of less than 10,000 or a county with a population of less than 25,000 at the time you graduated high school.

You come from a low income family with an annual income that does not exceed 200 percent of the Department’s poverty guidelines.

None of the above

Decline

Required

A copy of your responses will be emailed to the address you provided.

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