Spirit of EAGLESAmerican Indian/Alaska Native Leadership Initiative on Cancer

Student Application for MCAT/GRE Exam Preparation

WorkshopDecember 7-9, 2012

A Funding Source for:Undergraduate, Post Baccalaureate, Graduate, and

Medical School/Medical PreparatoryConference Assistance

Journal Publication AssistanceMedical School Application Assistance

U54-CA153605

Spirit of EAGLESAmerican Indian/Alaska Native Leadership Initiative on CancerAmerican Indian and Alaska Native (AI/AN) populations have very high incidence rates for specific cancer sites and poor survival rates for most cancers. This AI/AN Leadership Initiative on Cancer addresses comprehensive tribal cancer control through partnerships with The Network for Cancer Control Research among AI/AN populations, tribes, multiple cancer centers, and non-profit organizations on health issues. This Initiative will assist tribes 1) to increase community awareness and understanding of cancer, 2) to provide training in cancer control research for AI/AN researchers, and 3) to improve native community channels to the National Cancer Institute (NCI) so that research can be specifically focused on issues that affect Native people.

MCAT/GRE Preparation WorkshopThe Spirit of Eagles has recognized the importance of providing assistance to students preparing to take the very challenging and expensive MCAT and GRE Exams. We are offering a unique 1.5 day workshop for Pre-Medical and/or Pre-PhD Native American students who are planning to take the MCAT and/or the GRE Exams within the next year. This year our workshop will be held December 7-9, 2012 in Minneapolis, MN.Our featured speaker will be Jay Rosner, Executive Director of the Princeton Review Foundation. Jay has extensive experience in providing exam preparation presentations for MCAT, GRE, LSAT, and GMAT Exams. Jay works regularly with organizations - such as Graduate Horizons, College Horizons, and the Student National Medical Association – and has provided guidance to many students through our Spirit of EAGLES workshops.The cost of attendance is free. Exam preparation books will be provided to you at no cost. The Spirit of EAGLES will provide up to $500.00 for airfare/transportation costs. Meals and ground transportation will also be provided.

This application must be filled out and returned no later than 5pm CDT on Wednesday, November 7, 2012 to Marcy Averill, averill.marcy@mayo.edu.

Please fill in (type or print) answers to all of the questions. Use N/A if not applicable to you.

General Information:

Name:

                 

(Last) (First) (M.I.)

SSN:*

      Date of Birth:

     

*Social Security Number is required

mm dd yyyy

Age:       Sex: Female Male

Tribal Affiliation (if applicable):

     

Best telephone number to reach you at:

     

E-mail:

     

Home Address:     Street                 City State Zip Code

College Address:     Street                 City State Zip Code

College and Exam Information:

College Attending:      

Year in College:      

Med Prep Program College Program Medical School Graduate School

Other List:

     

Area(s) of Interest:

If you have previously taken the MCAT and/or GRE, please indicate your score(s) and the year the exam was taken:MCAT:       Year

:     

GRE:       Year:

     

If you have NOT, previously taken the MCAT and/or GRE, please indicate your approximate SAT and/or ACT score(s) and the year the exam was taken:SAT:       Year

:     

ACT:       Year:

     

Please note that the scores above are for informational purposes only – they will NOT affect your acceptance into this program.

need MCAT Preparation need GRE Preparation Date planned for MCAT/GRE:      

Have you attended a Spirit of EAGLES MCAT/GRE Preparation Workshop before?

Yes No

Reasons why you feel you would be a good candidate to be selected for this opportunity:

Please provide the following Attachments/Documents:

a) Copy of your latest official transcript listing current overall GPA

b) Letter of Support from academic personnel

     

     

If you have questions/concerns, please contact: Marcy AverillOperations Director for Spirit of EAGLESAmerican Indian/Alaska Native Initiative on CancerMayo Clinic(507)266-3064averill.marcy@mayo.eduProfessional Obligations Agreement:

1. Participants will attend all scheduled workshop activities.

2. Participants will limit use of cellphones and other technology during sessions to emergencies only.

3. Participants will report back to Spirit of EAGLES upon completion of the MCAT/GRE Exam with test outcomes.

4. Participants will provide updates to contact information and/or stay in touch with Spirit of EAGLES at least until accepted into Medical School or Graduate School.

5. Spirit of EAGLES will provide an introduction to exam preparation training via qualified and experienced trainer.

6. Spirit of EAGLES will provide exam preparation books at no cost.

7. Spirit of EAGLES will provide up to $500 for justified airfare/transportation costs.

8. Spirit of EAGLES will provide lodging, meals, and ground transportation.

9. Spirit of EAGLES will provide opportunities to stay involved with the program and to apply for ongoing/future support.

To acknowledge and agree to this agreement, please sign and date:

Signature:

      Date: