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MCAT Preparatory Course Form (2009-10)

Application Part A

Name (First, MI, Last)
Address
City, State, Zip Code
, ,
Phone Number
Student ID Number
E-Mail Address

Academic Year Junior Senior

When are you planning to take the MCAT? April (Spring 2010) August (Summer 2010)

Have you taken the MCAT before? No Yes

If yes, please indicate scores:
Date Verbal Bio Sci Phys Sci Writing Sample

Application Part B

Please read the following information carefully Please indicate your understanding and agreement with each of the following by checking the blank and signing your application:

The full course tuition of $675.00 must be paid in the form of a check or money order payable to the University of Wisconsin-Madison. A $100.00 non-refundable deposit is due in our office by July 1, 2009. The remaining $575.00 must be received by September 1, 2009. Please note that your deposit must be received by July 1, 2009 in order to hold your spot in the course. You will receive a reminder e-mail at the end of June, so please remember to check your e-mail over the summer. A limited number of partial tuition remissions are available. Please read Part D of this application and fill it out in order to apply.

You can bring your check to the College of Letters & Science Undergraduate Academic Servicess office, B18 Bascom Hall during our normal office hours (8:30-12:00 p.m., 1:00-4:00 p.m., M-F) or mail it to UAS, MCAT Course Coordinator, B18 Bascom Hall, 500 Lincoln Drive, Madison, WI 53706.

Your tuition includes a set of MCAT Prep books as well as access to three on-line MCAT Practice Tests, two of which you will have the opportunity to take in a simulated test environment during the spring semester. Additional on-line MCAT Practice Tests are available for $35 each; it will be up to you whether you wish to sign up for more and take them on your own time. Sign up online.

Are you planning to apply for the Fee Assisstance Program (FAP) through AAMC? Yes No

Application Part C

Commitment to Course Please indicate your understanding and agreement with each of the following by checking the blank:

I will be expected to prepare 5-7 hours minimum each week outside of class.

If I must miss a class, the course instructor is not responsible for assisting me with the missed information and work.

If I become unable to continue in the course at any time, I will notify the UAS office. (see below)

I may not give, sell, or otherwise transfer my seat in the course to another student on or after the first day of class.

I acknowledge that part of my tuition payment will fund partial tuition remissions for the MCAT course for students who meet University guidelines for financial need.

Application Part D

Letters and Science Advising Services will offer a limited number of partial tuition remissions to students who qualify based on their financial need. For these students, course tuition will be a total of $350.00. $100.00 will be payable to UW-Madison for the deposit due July 1, 2009; students will pay the remaining $250.00 by September 1, 2009.

Do you recieve financial aid from UW-Madison? Yes No
Do you give the L&S UAS Center permission to check
your record with the Office of Student Financial Services? Yes No

Application Submission

After submitting this application, please bring the following documents into our office:
- • A copy of your financial aid award letter from UW-Madison
- • A copy of your Student Aid Report
  (On My UW, print out your financial aid award information. Make sure this includes the amount of your family’s expected contribution)
You will hear from the course coordinator shortly about whether you will receive the partial tuition remission.
For more information, please contact:
Susan Nelson

Mail checks to:
UAS/MCAT Course Coordinator
B18 Bascom Hall
500 Lincoln Drive
Madison, WI 53706