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    University of Southern California
    Dornsife College of Letters, Arts & Sciences
    ATTN: Postbaccalaureate Premedical Program
    3620 South Vermont Avenue, KAP 358
    Los Angeles, CA 90089-2520
    Tel: (213) 821-2354

Postbaccalaureate Premedical Program
University of Southern California
Kaprielian Hall 358
Los Angeles, California 90089-2520

Preliminary Application Form

The information you provide on this form will help us make a preliminary evaluation of your eligibility for the program. Eligible students will be officially admitted into the program after completion and submission of a Graduate Student Application, verification of the information you submit on the application forms, and an interview.
If you do not have an Email address or if you prefer to send the form via regular mail, you can download the application form for printing by following this link

Spring    Summer    Fall    Year (ex: 2016)   
Career Goal :
Medicine    Dentistry    Veterinary Medicine   
Last: (Required) First: (Required) Middle: (Optional)
Legal Name:
Current Contact Address:

Baccalaureate Degree:
Major(s) (Required) Degree: (BA, BS, etc...)
Name of School (Required) Location (City/State)

All Colleges and Universities Attended:
You will need to provide transcripts for all schools listed below as part of the preliminary application

School Name Location
Date Attended Units GPA Degree
(if any)

Any College-level Science Courses Completed to Date:

Descriptive Name of Course College Letter
Date Taken

Have you ever been disciplined by any college, university, or professional school for: (1) unacceptable academic performance (academic probation, suspension, dismissal, etc.) or (2) conduct violations?

Yes No
If you answered "Yes" to the previous question, you must provide an explanation. Include 1) a brief description of the incident and/or arrest, 2) specific charge made, 3) related dates, 4) consequence, and 5) a reflection on the incident and how the incident has impacted your life.

Standardized Tests Scores:

Please Request ETS to send the USC Office of Graduate Admissions
an official report of your scores. (ETS Code 4852)

GRE General (Aptitude):
Date Verbal Quant. Anal.
Other Test (GMAT, LSAT):
Test Date Score

If you have never taken any postbaccalaureate tests,
please provide either your SAT or ACT test scores.

Date              Verbal Quant.
Critical Reading
Date Composite


Please request letters from two professors who can write about your motivation and readiness to undertake a rigorous program of study in the sciences. Letters from current or recent employers may be submitted instead, if it is inconvenient to obtain letters from former teachers.

Name School or Company

Current and Recent Activities:

If you have been out of school for more than one year, please briefly describe what you
have been doing. If you have an extensive employment record, you may cut and paste relevant
portions of your resume below or you may e-mail your resume to: Please limit
your statement to 200 words or less.

Personal Statement:

Please tell us why you wish to pursue medicine as a career. Please
limit your statement to one page or less.

Do you wish to receive information on financial aid?   Yes    No

I understand that the information submitted on this form is for preliminary evaluation of my
eligibility for the Postbaccalaureate Premedical Program. I understand that acceptance into
this program requires submission of the official Graduate School Application, verification of
information submitted on this form, and an interview.

  I understand and accept these conditions.
  I do not accept these conditions.

This form will be emailed to and a copy will be sent to the email address you provided above