The DC Health and Academic Prep Program 2020 - 2021 SCHOLAR APPLICATION - George ...
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The DC Health and Academic Prep Program
2020 - 2021 SCHOLAR APPLICATION
DC HAPP is a four-week summer pre-college pipeline program
coordinated by the George Washington University School of
Medicine and Health Sciences Office of Diversity and Inclusion to
increase access to healthcare careers for students with identities
underrepresented in medicine. Sixteen rising 12th-grade students
(currently enrolled 11th graders) attending Washington, DC
metropolitan area public and public charter schools are selected to
participate in DC HAPP program based on their passion and
potential for medicine.
DC HAPP scholars gain exposure to healthcare professions, learn
hands-on medical skills, develop public health projects, and
prepare for college applications and college life. Medical and public
health students, physicians, and other medical professionals serve
as mentors, facilitators, and teachers.
DC HAPP seeks to:
• Identify, recruit, and nurture talented District of Columbia
metropolitan area public and public charter school students
from backgrounds underrepresented in medicine who have an
interest in pursuing careers in the healthcare professions
• Establish connections between the community and healthcare
professionals, including, but not limited to, physicians, physician
assistants, nurses, physical therapists, and medical researchers
• Provide support and resources for program scholars to achieve
post-secondary academic success leading to professional
careers in the healthcare field
• Build relationships between scholars and the George
Washington University community
DC HAPP Calendar
If you are invited to participate in DC HAPP, your full investment is critical to your development as a
future medical professional. Please review this calendar carefully and confirm that you are available
for all dates before starting the application. The Scholar and Family Orientation is mandatory for
scholars and their parent/guardian. Scholars are required to attend each day of DC HAPP for the
full day.
Friday, March 13, 2020 Scholar applications due
Mid-April, 2020 Applicants notified of decisions
Saturday, June 20, 2020 (9:30 am-12:30 pm) Scholar and Family Orientation
June 29 - July 23, 2020 (9 am-5 pm) DC HAPP-week 1
July 6-10, 2020 (9 am-5 pm) DC HAPP-week 2
July 13-17, 2020 (9 am-5 pm) DC HAPP-week 3
July 20-23, 2020 (9 am-5 pm) DC HAPP-week 4
DC HAPP Summer Experience Closing Ceremony
Thursday, July 23, 2020 (5-7 pm)
(families invited)
On-going Relationship with GW community maintained
Example of Schedule from Last Year’s Summer Experience
Monday, July 1, 2019
9:30 am - 10:00 am Morning Check-In
10:00 am - 11:30 am Scholar Family Introduction
11:30 am - 1;00 pm GW Tour & Scholar Family lunch (bring your own lunch)
1:00 pm - 3:00 pm Application: Intro to Patient History Taking
3:00 pm - 4:00 pm Community Health Project Scholar Family Time
4:00 pm - 4:30 pm Closing
Tuesday, July 2, 2019
9:30 am - 9:45 am Morning Check-In
9:45 am - 10:45 am Health Professions Panel
11:00 am - Noon Lecture: What is Medicine?
Noon - 1:30 pm Lunch (bring your own lunch)
1:30 pm - 4:00 pm SUMMIT DAY: Low Ropes Course
4:00 pm - 4:30 pm Closing
Information & Instructions 2020 -2021
Page 1 of 3
Eligibility
• Academics
o Current student enrolled in the 11th grade at a public or public charter school in the District
of Columbia metropolitan area (includes MD and VA, as appropriate)
o Must be in good academic standing (minimum 2.0 GPA)
o Will be promoted to the next grade level for the following academic year
• Availability
o Able to attend DC HAPP Orientation (Saturday, June 20, 2020 9:30 am-12:30 pm) and
DC HAPP Summer Experience (weekdays June 29- July 23, 2020 9 am-5 pm)
o Does not have other responsibilities (employment or activities) that conflict with DC HAPP
Summer Experience
o Able to travel to the George Washington University Foggy Bottom campus and arrive on
time
• Interests/Ability
o Interested in learning from lectures by medical faculty and students
o Plans to pursue a profession in the healthcare field
o Will commit to maintain contact and follow up with mentor and program staff until high
school graduation (1-2 academic years) and beyond
• Character
o Self-motivated
o Responsible
o Positive attitude with desire to learn and grow
We are seeking to create a diverse cohort of students who can and will pursue a career in
healthcare. We encourage applicants to explore other summer opportunities in addition to applying to
DC HAPP as we receive significantly more applications than available spots in the DC HAPP cohort.
Stipend and Conduct
Each scholar earns a $2,000 stipend from the George Washington University School of Medicine and
Health Sciences Office of Diversity and Inclusion for the successful completion of DC HAPP.
Successful completion means attending and participating in all of DC HAPP with a positive learning
attitude.
Disorderly conduct, substance use, bullying, and non-compliance with reasonable staff instruction will
not be tolerated. Absences are not permitted. Scholars in violation of the DC HAPP Code of Conduct
will be expelled from the program and will not be eligible for the DC HAPP scholar stipend.
DC HAPP Contact
Please contact the George Washington University School of Medicine and Health Sciences Office of
Diversity and Inclusion DC HAPP Committee if you have any questions about DC HAPP or applying
to the program. You can email dchapp@gwu.edu or call 202-994-6962.
You can also view our website at go.gwu.edu/dchapp for more information.
Information & Instructions 2020 -2021
Page 2 of 3Application
Required Parts
Section Parts Page Completed By
a. Student Certification of Authenticity Student AND
Cover Page 1
b. Agreement to DC HAPP Policies Parent/Guardian
a. Student Contact Information
1. Student Profile b. Student Demographics 2
c. Student Background Student and/or
Parent/Guardian
a & b. Parent/Guardian Information
2. Family Profile 3
c. Family Background
a. School Information
b. Academic Information
Student AND
3. Education c. Science Courses 4
Parent/Guardian
d. Math Courses
e. Authorization to Release Records
4. Activities List of activities/jobs 5 Student ONLY
a. Essay 1-Medicine Interest
5. Personal Essays 6-7 Student ONLY
b. Essay 2-Experience from Life
a. Academic Evaluation AE 1-2 Teacher
6. Evaluations
b. Evaluation E 1-2 Unrelated Adult
7. Official, current high school transcript signed by a school official. Transcript must include grades
from 1st semester (quarter 1 and quarter 2) of this academic year (2019-2020).
Submission Instructions
Fill out pages 1-7 of the application
Signatures must be physical; sign pages 1& 4 with pen (no digital/typed signatures).
Request an official, current high school transcript from your school registrar or counselor.
Include the transcript with your application or have your school send it directly.
Email (preferred) or mail pages 1-7 (and transcript if your school is not sending it directly).
Do NOT drop your application off; building security does not permit unauthorized
guests.
Fill out your name on the 2 evaluations and ask 2 adults to submit an evaluation directly.
Only 2 evaluations will be reviewed; do not submit more than 2 evaluations.
Scan and email US Postal Mail:
(preferred): The George Washington University
dchapp@gwu.edu School of Medicine & Health Sciences Office of Diversity and Inclusion
DC HAPP
Ross Hall, Suite 708
2300 Eye St., NW
Washington, DC 20037
Due Date
All parts (student application, evaluations, and school transcript) must be received by the School of
Medicine and Health Sciences Office of Diversity and Inclusion by Friday, March 13, 2020.
Late submissions, including those that are incomplete by the deadline, cannot be accepted as
we receive more applications than available spots.
Notification
Applicants will be notified of their application status (invited to participate, placed on waitlist, not
invited) via email in mid-April.
Information & Instructions 2020 -2021
Page 3 of 3This page to be completed by student AND parent/guardian
Cover Page
a. Student Certification of Authenticity
Read, check the box that you agree, sign, and date.
☐ I, the student, certify that all information I provide in the application process is factually true,
honestly presented, and the personal essays I am submitting are my own work. I understand
that these documents will not be returned to me. I understand that I may be subject to a range of
disciplinary actions, including acceptance revocation or expulsion from DC HAPP, should the
information I certify be false.
Student Full Name (Print)
Student Signature Date
Physical (written) signatures only; typed/digital signatures not permitted.
b. Agreement to DC HAPP Policies
Read, check the boxes that you agree, sign, and date.
☐ We, the student and parent/guardian, understand that if the student is invited to participate in
DC HAPP, the student and their parent/guardian must attend the Scholar and Family Orientation
on Saturday, June 20, 2020 from 9:30 am to 12:30 pm and the student must attend the entirety
of the Summer Experience from June 29 – July 23, 2020.
☐ We understand that if the student is invited to participate in DC HAPP, the student and
parent/guardian will be expected to agree to the DC HAPP Code of Conduct. If the student does
not follow the DC HAPP Code of Conduct, including, but not limited to, absences, disorderly
conduct, substance use, bullying, or non-compliance with reasonable staff instructions, they will
be expelled from the program.
☐ We understand that if the student is invited to participate in DC HAPP, the student will only earn
the scholar stipend upon successful completion of DC HAPP. If the student’s acceptance is
revoked or the student is expelled at any point, they will not be eligible for the scholar stipend.
We understand that DC HAPP stipends are not pro-rated.
Student Signature Date
Physical (written) signatures only; typed/digital signatures not permitted.
Parent/Guardian Name (Print)
Parent/Guardian Signature Date
Physical (written) signatures only; typed/digital signatures not permitted.
Application 2020 - 2021
Page 1 of 7This page to be completed by student and/or parent/guardian.
1. Student Profile
All information required
a. Student Contact Information
First name: Last name:
Preferred first name (if different):
Student Email:
Student Phone:
Student Address:
Street address, with unit number if applicable
City State Zip code
b. Student Demographics
Date of birth: Gender:
☐ American Indian/Native American
☐ Asian/Desi
☐ Black/African American
Racial/ethnic background: ☐ Latinx/Hispanic
(select one or more) ☐ Middle Eastern/North African
☐ Native Hawaiian and other Pacific Islander
☐ White
☐ Other: _________________________________
c. Student Background
Primary language(s):
☐ United States citizen or dual citizen
City and state of birth: ____________________________________
Citizenship/place of birth: ☐ United States permanent resident or refugee
(select one) Country of birth: _________________________________________
☐ Other (Non-US)
Country of citizenship: ____________________________________
☐ Yes
Will the student (or siblings) be the first in the family to attend a 4-
☐ No
year college in the United States (first generation college student)?
☐ Do not know
Application 2020 - 2021
Page 2 of 7This page to be completed by student and/or parent/guardian.
2. Family Profile
All information required
a. Parent/Guardian Information
Parent/Guardian full name:
Relationship to student:
Phone number 1: ☐Cell ☐Home ☐Work
Phone number 2: ☐Cell ☐Home ☐Work
Email:
Address:
Street address, with unit number if applicable
City State Zip code
b. Parent/Guardian (OR next emergency contact) Information
Name:
Relationship to student:
Phone number 1: ☐Cell ☐Home ☐Work
Phone number 2: ☐Cell ☐Home ☐Work
Email:
Address:
Street address, with unit number if applicable
City State Zip code
c. Family Background
☐ Yes
Is anyone in the student’s family a Relationship to student: _____________________
health professional? Profession: _______________________________
☐ No
Is the student’s family eligible for the ☐ Yes
Free and Reduced Price School Meals ☐ No
program? ☐ Do not know
Application 2020 - 2021
Page 3 of 7This page to be completed by student AND parent/guardian.
3. Education
All information required
a. School Information
High school name:
School phone:
Counselor or other school
point of contact name:
Counselor/point of contact
phone: Email:
b. Academic Information
Anticipated year of graduation:
Current unweighted GPA:
c. Science Courses
List the course name (e.g. Biology, Chemistry, Physics, etc.) and level (e.g. Honors, AP) for each grade,
including planned courses for 12th grade.
9th Grade 10th Grade 11th Grade 12th Grade
(completed) (completed) (current) (planned)
d. Math Courses
List the course name (e.g. Algebra, Geometry, Pre-Calc, etc.) and level (e.g. Honors, AP) for each grade,
including planned courses for 12th grade.
9th Grade 10th Grade 11th Grade 12th Grade
(completed) (current or completed) (current) (planned)
e. Authorization to Release Student Records
I give permission for the George Washington University School of Medicine & Health Sciences Office
of Diversity and Inclusion staff to request and access _________________________’s (student full
name) school records, including grades and test scores, to apply to the DC Health and Academic Prep
Program (DC HAPP).
Student Full Name (Print)
Student Signature Date
Physical (written) signatures only; typed/digital signatures not permitted.
Parent/Guardian Name (Print)
Parent/Guardian Signature Date
Physical (written) signatures only; typed/digital signatures not permitted.
Application 2020 - 2021
Page 4 of 7This page to be completed ONLY by student
4. Activities
List all activities, jobs, and family commitments; include length of involvement and frequency.
A one-page resume may be submitted instead.
Required; one page maximum.
Application 2020 - 2021
Page 5 of 7This page to be completed ONLY by student
5a. Personal Essay 1
In what healthcare profession(s) and specialties are you interested? Why do you want to be a
healthcare professional? Required; 300 word minimum, 400 word maximum.
Application 2020 - 2021
Page 6 of 7This page to be completed ONLY by student
5b. Personal Essay 2
What is an experience from your life that has helped you become who you are today? Please
describe. Required; 300 word minimum, 400 word maximum.
Application 2020 - 2021
Page 7 of 7This page intentionally left blank.
Academic Evaluation
DC HAPP 2020
TO THE APPLICANT
After filling out your name, ask a teacher who has taught you during high school (ideally a math or
science subject) to fill out this evaluation. If both of your evaluators are teachers, use this form twice.
Student first Student last
name: name:
TO THE TEACHER
The above student is applying to participate in DC HAPP, a pre-college program coordinated by the
George Washington University School of Medicine and Health Sciences Office of Diversity and
Inclusion to increase access to healthcare careers for students with identities underrepresented in
medicine. Sixteen rising 12th-grade students attending Washington, DC area public schools are
selected to participate in a four-week summer experience based on their passion and potential for
medicine. DC HAPP scholars gain exposure to healthcare professions, learn hands-on medical skills,
develop public health projects, and prepare for college applications and college life.
DC HAPP seeks to admit students who have the ability and motivation to pursue medical education,
especially those who might benefit from intensive mentoring and support. Your insights in to the
maturity level and potential of this student are instrumental to our selection process. Thank you.
Please note that this evaluation intentionally mirrors the Common Application Teacher Evaluation to aid in future evaluations
of the student.
Please submit both pages of this evaluation via email (preferred) or mail by Friday, March 13, 2020.
Email (preferred): US Postal Mail:
dchapp@gwu.edu The George Washington University
School of Medicine & Health Sciences Office of Diversity and Inclusion
DC HAPP
Ross Hall, Suite 708
2300 Eye St., NW
Washington, DC 20037
Teacher’s name:
Teacher’s telephone: Teacher’s email:
Teacher’s signature:
Background Information
In which grade level(s) was the student enrolled when you taught him/her? ☐9th ☐10th ☐11th
List the subject area in which you have taught this student, including the level of course difficulty.
What are the first words that come to your mind to describe this student?
Academic Evaluation (Teacher) 2020 - 2021
Page 1 of 2Academic Evaluation
DC HAPP 2020
Student first Student last
name: name:
Teacher’s name:
Ratings
Compared to other students in his or her class year, how do you rate this student regarding:
Very good
No Below Good (above Excellent Outstanding
Average (well above
basis average average) (top 10%) (top 5%)
average)
☐ Academic achievement ☐ ☐ ☐ ☐ ☐ ☐
☐ Intellectual promise ☐ ☐ ☐ ☐ ☐ ☐
☐ Quality of writing ☐ ☐ ☐ ☐ ☐ ☐
☐ Creative, original thought ☐ ☐ ☐ ☐ ☐ ☐
☐ Productive class discussion ☐ ☐ ☐ ☐ ☐ ☐
Respect accorded by
☐ faculty
☐ ☐ ☐ ☐ ☐ ☐
☐ Disciplined work habits ☐ ☐ ☐ ☐ ☐ ☐
☐ Maturity ☐ ☐ ☐ ☐ ☐ ☐
☐ Motivation ☐ ☐ ☐ ☐ ☐ ☐
☐ Leadership ☐ ☐ ☐ ☐ ☐ ☐
☐ Integrity ☐ ☐ ☐ ☐ ☐ ☐
☐ Reaction to setbacks ☐ ☐ ☐ ☐ ☐ ☐
☐ Ability to empathize ☐ ☐ ☐ ☐ ☐ ☐
☐ Self-confidence ☐ ☐ ☐ ☐ ☐ ☐
☐ Initiative, independence ☐ ☐ ☐ ☐ ☐ ☐
Evaluation
Please provide comments about this student, including a description of academic and personal characteristics,
as demonstrated in your classroom. We welcome information that will help us to differentiate this student from
others, including their interest in medicine and their potential to benefit from DC HAPP. Please use additional
pages if necessary.
Academic Evaluation (Teacher) 2020 - 2021
Page 2 of 2Evaluation
DC HAPP 2020 - 2021
TO THE APPLICANT
After filling out your name, ask an adult who knows you well to fill out this evaluation. This adult
cannot be a person who is related to you. You should, ideally, ask an adult who has observed you in
a structured setting and knows about your interest in pursuing a medical profession. For example,
your guidance counselor, employer, religious leader, club/activity advisor/leader, athletic coach,
internship director, or tutor, are all great adults to ask.
Student first Student last
name: name:
TO THE EVALUATOR
The above student is applying to participate in DC HAPP, a pre-college program coordinated by the
George Washington University School of Medicine and Health Sciences Office of Diversity and
Inclusion to increase access to healthcare careers for students with identities underrepresented in
medicine. Sixteen rising 12th-grade students attending Washington, DC area public schools are
selected to participate in a four-week summer experience program based on their passion and
potential for medicine. DC HAPP scholars gain exposure to healthcare professions, learn hands-on
medical skills, develop public health projects, and prepare for college applications and college life.
DC HAPP seeks to admit students who have the ability and motivation to pursue medical education,
especially those who might benefit from intensive mentoring and support. Your insights in to the
maturity level and potential of this student are instrumental to our selection process. Thank you.
Please submit both pages of this evaluation via email (preferred) or mail by Friday, March 13, 2020.
Email (preferred): US Postal Mail:
dchapp@gwu.edu The George Washington University
School of Medicine & Health Sciences Office of Diversity and Inclusion
DC HAPP
Ross Hall, Suite 708
2300 Eye St., NW
Washington, DC 20037
Evaluator’s name:
Evaluator’s signature:
Evaluator’s telephone: Evaluator’s email:
Background Information
How long have you known the applicant and in what context?
What are the first words that come to your mind to describe this applicant?
Evaluation 2020 - 2021
Page 1 of 2Evaluation
DC HAPP 2020 - 2021
Student first Student last
name: name:
Evaluator’s name:
Ratings
Compared to other young people in their age group, how do you rate this applicant regarding:
Very good
No Below Good (above Excellent Outstanding
Average (well above
basis average average) (top 10%) (top 5%)
average)
☐ Intellectual promise ☐ ☐ ☐ ☐ ☐ ☐
☐ Quality of writing ☐ ☐ ☐ ☐ ☐ ☐
☐ Creative, original thought ☐ ☐ ☐ ☐ ☐ ☐
☐ Respect shown to adults ☐ ☐ ☐ ☐ ☐ ☐
☐ Disciplined work habits ☐ ☐ ☐ ☐ ☐ ☐
☐ Maturity ☐ ☐ ☐ ☐ ☐ ☐
☐ Motivation ☐ ☐ ☐ ☐ ☐ ☐
☐ Leadership ☐ ☐ ☐ ☐ ☐ ☐
☐ Integrity ☐ ☐ ☐ ☐ ☐ ☐
☐ Reaction to setbacks ☐ ☐ ☐ ☐ ☐ ☐
☐ Ability to empathize ☐ ☐ ☐ ☐ ☐ ☐
☐ Self-confidence ☐ ☐ ☐ ☐ ☐ ☐
☐ Initiative, independence ☐ ☐ ☐ ☐ ☐ ☐
Evaluation
Please provide comments that will help us differentiate this student from others and their potential to benefit
from DC HAPP. We encourage you to consider describing or addressing the student’s extracurricular activities
and personal characteristics, particularly their interest in medicine. Please use additional pages if necessary.
Evaluation 2020 - 2021
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