Application deadline: january 17, 2014 (Late applications will be reviewed on space available basis) Questions? Please call: Selma High School: (559) 495-6416



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APPLICATION DEADLINE:

JANUARY 17, 2014

(Late applications will be reviewed on space available basis)
Questions? Please call:

Selma High School: (559) 495-6416

University of California, San Francisco, Fresno

Latino Center for Medical Education and Research (LaCMER)

D O C T O R S A C A D E M Y


Admission Application
for Selma High School

2014 – 2015
DEADLINE: JANUARY 17, 2014


Participating Schools:

Caruthers High School Selma High School




Key Partners:

 University of California, San Francisco School of Medicine  University of California, San Francisco Medical Education Program Fresno  University of California, San Francisco School of Pharmacy  University of California, San Francisco School of Dentistry  California State University, Fresno   University of California, Merced  Fresno County Office of Education  Caruthers Unified School District  Fresno Unified School District Selma Unified School District  Community College State Center District  Community Regional Medical Centers  Kaiser Permanente, Fresno



Funded in part by,

University of California, San Francisco, School of Medicine The California Wellness Foundation

OSHPD Wells Fargo Bank The California Endowment

THE DOCTORS ACADEMY PROGRAM

Program Eligibility:

Under the auspices of the University of California, San Francisco, Fresno Latino Center for Medical Education and Research, the Doctors Academy is a health professions preparatory high school program. Applicants who are educationally OR economically disadvantaged, and who express an interest in a health professional career are eligible to apply. Participants of the Doctors Academy must be United States citizens, non-citizen nationals, or foreign nationals who possess a VISA permitting permanent residence in the United States.


___Educationally Disadvantaged: For the purpose of program eligibility, an applicant is considered educationally disadvantaged if he or she is the first in the immediate family to pursue a BA/BS degree or higher. [Applicants who have at least one parent/guardian with a BA/BS degree or higher are considered ineligible for the Doctors Academy program.]

- OR -
___Economically Disadvantaged: For the purpose of program eligibility, an applicant is considered economically disadvantaged if he or she was eligible for the Free and Reduced Lunch Program (Title I services) during the 8th grade year. [Applicants who did not qualify for Title I services due the parent/guardian income level are considered ineligible to apply for the Doctors Academy program.]
IF YOU ARE ELIGIBLE, PLEASE CONTINUE WITH THE APPLICATION PROCESS
Selection criteria is based on:

  • GPA of 2.8 or better ● Personal Statement

  • Two Letters of Recommendation ● Personal Interview

  • Health Disparity Essay ● A writing sample may be required for finalists

The mission of the Doctors Academy is:

1. To increase the number of students who graduate from high school and go on to a university to become competitive applicants to health profession schools.

2. To strengthen the educational pipeline of under-represented or disadvantaged students throughout Fresno County and encourage them to enter a health profession.
Expectations of Doctors Academy students:


  1. Enroll in the most rigorous, accelerated classes with an emphasis on math, science, and English. (Honors & Advanced Placement)

  2. Commit to the Doctors Academy five-year study plan

  3. Maintain a 2.8 academic grade point average (GPA)

  4. Participate in summer enrichment and summer school programs

  5. Participate in study academies, study trips, and other activities

  6. Students accepted into the Doctors Academy will be responsible for their own transportation.

  7. Students who are dropped or choose to withdraw from the Doctors Academy program will return to their home high school if it is other than the Doctors Academy site.

The information requested is in compliance with the “Health Professionals Education Partnerships Act of 1998” P.L. 105-392, reauthorized and amended section 739 of the PHS Act (Educational Assistance in the Health Professions Regarding Individuals from Disadvantaged Backgrounds).
STUDENT INFORMATION

Academic Enrollment Year 2014-2015 – Selma High School

Entering Grade Level: 9th
Student ID#:___________ Name: __________________________________________________________________ Male ___ Female ____
Date of Birth (mo/day/year): _____________________ Social Security #:_(only list the last four digits) XXX-XX-______

Address: ___________________________________________________________City: _________________ Zip Code: ______


Home Phone #: ___________________________________ Cell Phone # _______________________________
Email address: _____________________________________________________________________________
Middle School: __________________________________________________________________ Current GPA: _______
Home High School for 2014-2015:_______________________________________________________________________________



  • Indicate the health or medical profession are you most interested in: ______________________________________


Student Signature ____________________________________________________________________Date__________________
PRIMARY PARENT(S)/GUARDIAN(S) INFORMATION

Father’s/Guardian Name: ___________________________________Work phone #__________________ Cell # ____________________


Mother’s/Guardian Name: __________________________________Work phone #__________________Cell # ____________________

Legal Parent/ Guardian Address: _____________________________________________City: _________________ Zip Code: ________


Email address: __________________________________________________________________________
Child’s Ethnicity (for statistical purposes only):


  • ___ African-American ___ American Indian ___ Caucasian ___Latino

    ___ Asian: Chinese Japanese Korean Cambodian Hmong

    □Laotian Thailand Philippine Islands Vietnamese Asian Indian
    ___ Native Hawaiian or Other Pacific Islander ___ Other (Please specify)______________________















  • Language most frequently spoken at home: ________________________________




  • Preferred language for written materials: ________________________________




  • Did your child qualify to receive reduced or free lunch during the 2013-14 School Year? __ Yes __ No


Highest level of education completed by:

Mother/Guardian Father/Guardian

__ Did not finish high school __ High school graduate __ Did not finish high school __ High school graduate

__ Some college __ AA/AS Degree __ Some college __ AA/AS Degree

__ BA/BS Degree __ Master’s Degree __ BA/BS Degree __ Master’s Degree

__ Doctorate Degree __ Doctorate Degree


Legal Parent/Guardian Signature _______________________________________ Date_____________


Two Essays are required for the Doctors Academy application.

These must be in your own words.

(Please pay attention to format, grammar, punctuation, and proper citations. Plagiarism will result in an automatic disqualification of an application.)

PERSONAL STATEMENT ESSAY
Essay 1. Please provide a 1-2 page essay addressing the following:


    • Why you have chosen to apply to the Doctors Academy.

    • How you have prepared yourself academically for high school.

    • Tell us about your talent, experience, personal quality and the contributions you would bring to the Doctors Academy.



HEALTH DISPARITY ESSAY
Essay 2. On a separate sheet, please provide a minimum of two paragraphs that describe the following:

  1. In your own words, please define health disparity

  2. Provide an example of at least one health disparity within your community.

(Please type or print legibly in ink.)



Student’s Name: _______________________________
(Must be from a Math, Science or English Teacher)

DUE BY: JANUARY 17, 2014


D O C T O R S A C A D E M Y




LETTER OF RECOMMENDATION # 1



To Evaluator: The letter of recommendation is a valued component of the admission process. Please provide your evaluation of the candidate’s abilities. To the applicant and evaluator: It is understood that this letter of recommendation will be maintained in confidence by UCSF Fresno Latino Center for Medical Education and Research and will be used as one factor in considering admission to the Doctors Academy. In accordance with the Family Education Rights and Privacy Act of 1977, and the related policies and regulations, it is also understood that upon request, this letter will be made available to the applicant for examination.






Excellent


Good


Average


Below Average


Communication skills













Motivation and effort













Study habits













Ability to interact well with others













Academic ability













Imagination and creativity













Organization skills













Citizenship













Please provide a brief paragraph about the student, include student’s attributes/characteristics


Additional comments:


_____ I do recommend this student.
_____ I do not recommend this student.
Evaluator’s Name: __________________________________________________________________________________

(Please Print)

Title/Position: ____________________________________________________ Phone Number: _____________________
School: __________________________________________________________________________________________
Signature: ____________________________________________________________________ Date: _______________

Please place this letter of recommendation in a sealed envelope and give to the student to submit with application. Questions? Please contact the DA school site:

Selma High School, Principal, Mark Babiarz @ 898-6550 or email: MBabiarz@Selma.k12.ca.us


Student’s Name: _______________________________
(Must be from a Math, Science or English Teacher)

DUE BY: JANUARY 17, 2014


D O C T O R S A C A D E M Y




LETTER OF RECOMMENDATION # 2



To Evaluator: The letter of recommendation is a valued component of the admission process. Please provide your evaluation of the candidate’s abilities. To the applicant and evaluator: It is understood that this letter of recommendation will be maintained in confidence by UCSF Fresno Latino Center for Medical Education and Research and will be used as one factor in considering admission to the Doctors Academy. In accordance with the Family Education Rights and Privacy Act of 1977, and the related policies and regulations, it is also understood that upon request, this letter will be made available to the applicant for examination.






Excellent


Good


Average


Below Average


Communication skills













Motivation and effort













Study habits













Ability to interact well with others













Academic ability













Imagination and creativity













Organization skills













Citizenship













Please provide a brief paragraph about the student, include student’s attributes/characteristics


Additional comments:


_____ I do recommend this student.
_____ I do not recommend this student.
Evaluator’s Name: __________________________________________________________________________________

(Please Print)

Title/Position: ____________________________________________________ Phone Number: _____________________
School: __________________________________________________________________________________________
Signature: ____________________________________________________________________ Date: _______________

Please place this letter of recommendation in a sealed envelope and give to the student to submit with application. Questions? Please contact the DA school site:

Selma High School, Principal, Mark Babiarz @ 898-6550 or email: MBabiarz@Selma.k12.ca.us


DOCTORS ACADEMY APPLICATION PROCESS
DOCTORS ACADEMY APPLICATION CHECK LIST:

Complete and review that your application is typed or printed legibly in ink, and includes the following items:

 Student and Parent Information (include parent and student signatures)

 Student Social Security number

 Personal Statement & Health Disparity Essay

7TH & 8th grade (1st semester report card) transcripts

 Two Letters of Recommendation in sealed envelope


MAILING INFORMATION:
MAIL COMPLETE APPLICATION BY FRIDAY, JANUARY 17, 2014

Only complete applications will be reviewed. See checklist above for what makes a complete application.
Complete Application MUST be sent to:


Abraham Lincoln Middle School

Attn: Megan Borboa

1239 Nelson Blvd.

Selma, CA. 93662




IMPORTANT TIMELINES:
February 2014- Interviews for finalists March 2014- Acceptance Notices

Program Administrators:

Selma High School – Selma, California


Mark Babiarz, Principal (559) 898-6550 mbabiarz@Selma.k12.ca.us

Luis Collazo (559) 898-6550 lcollazo@Selma.k12.ca.us

UCSF Fresno Latino Center for Medical Education and Research


Katherine A. Flores, MD, Director (559) 241-7670 kflores@fresno.ucsf.edu

Bertha A. Dominguez, Education Director (559) 241-7670 bdominguez@fresno.ucsf.edu

SELMA HIGH SCHOOL DOCTORS ACADEMY

COURSE PROJECTION SHEET



Year


Summer

Class

Suggested Courses


(3-4 Courses)

Activities


Recommended College Tests

Conferences/

Workshops

Volunteer Opportunities

YEAR 1

Summer Transition Program



  • University Study

FRESHMEN


DA AVID 1P

English 1P

Biology P

Integrated Math 1P

Spanish 1 or Spanish 2

Physical Education



  • Saturday Academy

  • Health Professional Guest Speakers

  • Medical and Health Related Readings

  • University Study Trips

  • PSAT/PLAN

  • College Application Workshops




  • Financial Aid/Scholarship Workshop




  • Personal Statement Workshop




  • Parent Empowerment Workshops




  • Saturday Academies




  • Scholastic Achievement Test (SAT) Preparatory Course

Local Volunteer Opportunities

  • American Cancer Society

  • American Heart Association

  • American Lung Association

  • Central California Blood Drive

  • Elementary and Middle School Presentations

  • Health Fair



Volunteer Opportunity Locations:

  • Adventist Health: Community Hospital and Health Care Centers




  • Children’s Hospital Central California




  • Clinica Sierra Vista




  • Community Regional Medical Center, Fresno




  • Fresno County Department of Public Health




  • Kaiser Permanente, Fresno and Selma, CA

YEAR 2

World History




SOPHOMORES

DA AVID 2P

English 2P

Chemistry P or

Integrated Math 2P

Spanish 2 of Spanish 3

World History P or

AP European History

Physical Education



  • Saturday Academy

  • Health Professional Guest Speakers

  • Medical and Health Related Readings

  • University Study Trips

  • PSAT/PLAN

YEAR 3


JUNIORS


DA AVID 3P

English 3 AP or AP Eng Lang

Physics or Anatomy/Physiology

Integrated Math 3P

Spanish 3 of AP Spanish

US History P or

AP US History


  • Saturday Academy

  • Health Professional Guest Speakers

  • Medical and Health Related Readings

  • University Study Trips

  • PSAT/PLAN

  • ACT Test

  • SAT I and II

  • AP Exams

YEAR 4

Senior Summer Shadows

Internship Program (competitive opportunity)
Or Econ P


SENIORS

DA AVID 4P

English 4P or AP Eng Lit

AP Bio or AP Chem

Govt P & AP Govt

Trigonometry/Pre-calculus or AP Calculus

Elective


  • Saturday Academy

  • Health Professional Guest Speakers

  • Medical and Health Related Readings

  • University Study Trips

  • SAT I and II

  • ACT Test

  • AP Exams

YEAR 5

Attend College Orientation

Meet with Academic Advisor

Summer Job or Summer Research/Internship Programs (SMDEP)


COLLEGE FRESHMEN

  • Fall Semester class schedule

  • Spring Semester class schedule

  • Summer Semester class schedule

* units may vary based on institution & financial aid



Apply for college scholarships

Extra-curricular activities

Pre-Med Support Programs (HCOP, EOP)

DA Alumni networking

K-12 Outreach


Placement Tests:

ELM/EPT (CSUs)

ELRW/MAE (UCs)

Private college test may vary




Pre-Med conferences

    • AMSA

    • SUMMA

    • UCSF Pharmacy

Day

    • LMSA




  • Community Service

  • Local Hospitals

  • Non-Profit Agencies

  • College Volunteer Events

UCSF Fresno LaCMER Summer Clinical & Community Program


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