File Creation Form
University of Mary Washington
Premedical Advisory Board
2008

The submission of this form to the Premedical Advisor officially creates your file with the Premedical Advisory Board of the University of Mary Washington. This file will eventually hold a copy of your undergraduate transcripts, the various forms and waivers you have been asked to fill out and sign, a copy of the recommendations you solicit from faculty and others, and Board members' comments on your interview with the Board. Access to this file is limited to the members of the Premedical Advisory Board for the exclusive purpose of preparing an evaluation/recommendation of the applicant for medical and/or dental school. It may also be used, at your request, to support applications for specialized premedical certificate programs, should you decide to apply to such programs. This file will not be used for any other purpose. If you have any questions concerning the use of this file, please contact Dr. Kathy Loesser, via e-mail at kloesser@umw.edu or via phone at (540) 654-1416.

Required Fields: Required fields are indicated by an asterisk*.

Security: The information you provide here is stored in a password protected file on a secure server.

Name*:   (Input your name as it will likely appear on your medical or dental school application.)  

 SSN*: (e.g., 123-45-6789)

Local Address*
(input your campus address or your off-campus street address, city, state, zip code):

Local Phone* (include area code): (e.g., 540-654-9999)

Home Address* (include street address, city, state, zip code):

Home Phone* (include area code): (e.g., 540-123-4567)

Please enter your e-mail addresses below. These are extremely important. The Premedical/Predental Advisor will most-likely contact you via e-mail.

UMW e-mail address*:

Summer e-mail address*:

UMW Academic Level*:

UMW Academic Major Program*:     

UMW Degree Path*:

If you hold any degrees from any other institution,
indicated the degree and the granting institution:

Are you a transfer student?*   

If so, from which institution did you transfer?

How many total credits did you transfer?