Composite of Achievements and Activities

Name:       Date of Graduation:
Major:       Minor:
Health Professions Program:   MD      DO      DDS      DVM     Other:

A. SCHOLARSHIPS AWARDED

1. Name of Scholarship:       Years Awarded:
2. Name of Scholarship:       Years Awarded:

B. ACADEMIC LINK TUTOR

Semesters Served as a Tutor:
Subjects Tutored:
CRAL Certification: Yes      No
  If yes, indicate level I or level II:
  Level I      Level II

C. SUPPLEMENTAL INSTRUCTION

Semesters as an SI Mentor:
Courses:

D. PARTICIPATION IN COLLEGIATE SPORTS

1. Name of Sport:
Dates Played:
Leadership Position Held:
2. Name of Sport:
Dates Played:
Leadership Position Held:

E. MEMBERSHIP IN HONOR SOCIETIES

1. Name of Honor Society:
Dates of Membership:
Type of Society:
Leadership Position:
Dates at this Position:
2. Name of Honor Society:
Dates of Membership:
Type of Society:
Leadership Position:
Dates at this Position:

F. MEMBERSHIP IN COLLEGIATE CLUBS AND ORGANIZATIONS (SERVICE CORPS, SGA, GREEN SHIRTS)

1. Name of Organization:
Dates of Activities:
Leadership Position:
Dates at this Position:
2. Name of Organization:
Dates of Activities:
Leadership Position:
Dates at this Position:

G. COMMUNITY INVOLVEMENT

1. Organization:
Dates of Participation:
Description of Activity:
Leadership Position Held:
Dates at this Position:
2. Organization:
Dates of Participation:
Description of Activity:
Leadership Position Held:
Dates at this Position:

OTHER INFORMATION

  
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